by Kim Bellard, December 14, 2016
Health care fraud is bad. Everyone agrees about that (except those who profit by it). We'd similarly agree it is all too pervasive. Some estimate that fraud could account for up to 10% of health care spending. But that's chump change: estimates are that other kinds of wasteful spending, such as unnecessary care and excessive administrative costs, are easily double that.
An op-ed in The Boston Globe may have it right: we need an overdiagnosis awareness month.The op-ed was a tongue-in-cheek suggestion to highlight the various cancer awareness months, the most famous of which is October's Breast Cancer Awareness. These campaigns promote the need for the associated screenings, but don't typically also mention how controversial many of them are.
Overdiagnosis goes much further than screenings. As Atul Gawande wrote last year, we're getting an "avalanche of unnecessary care," getting too many services of not just low value but of at best no value to patients -- and, at worse, actually harmful to them. Not just pointless tests or unneeded prescriptions, but also too many questionable procedures, such as total knee replacements, heart stents, or spinal fusions.
The real problem is that most people involved in the "epidemic" of overdiagnosis and over-treatment our health care system, well, they think they're just doing their jobs.
They don't think they're trying to rip anyone off, they certainly don't think that they're harming anyone, and they most definitely don't think their role is superfluous. This is all only possible because it is still too hazy about what is the right treatment for who, when, not to mention what a "fair" price might be for anything. So, when in doubt, do more.
As a result, health care employment is booming. Some project it will be largest job sector within three years. Indeed, as the chart below shows, virtually all of the U.S. job growth this century has been in health care jobs. That, quite simply, is astounding.
Yet, despite all this growth, there continue to be urgent cries of shortages of key health care professionals. We just cannot seem to get enough qualified health care workers. If you're looking for a job, that's good news, but if you're paying the bill for all those jobs, it should be scary.
In health care, we just add more jobs.
Overtreatment works, at least if you're the one doing the treating.
And everyone in health care keeps doing their job.
Look, this fantasy isn't going to continue. Health care isn't going to become 100% of GDP. It's not going to get to 50%, or 40%. At some point the revolt will happen, the revolution will occur, and health care spending will finally slow, stop, and eventually plunge.
Then all those health care jobs are not safe. People will lose their jobs. A lot of people. People who, until then, thought they were doing good.
So when the next health care innovator comes along, we should try to get past the hype and ask: OK, specifically, what jobs will this eliminate -- which ones, how many, when? If they don't have answers, or only offer vague promises, well, smile politely and get out your wallet.
In health care, perhaps one way to do your job might just be to find a way to eliminate it.