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We Won’t Solve American Health Care Until Doctors Stop Overtreating And Overbilling

If America wants universal healthcare, it must confront the gratuitous waste of medical resources by the doctors entrusted to steward them.

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Every good story needs a villain. In the story of America’s health care system, that villain has long been the insurance companies and the executives who run them. They deny claims, impose burdensome prior authorization requirements, restrict access to care, and routinely insert themselves between patients and the physicians treating them. When Americans receive an inexplicable medical bill or are told that a treatment their doctor recommended will not be covered, the villain seems obvious. But what if there is another villain in this story — one hiding in plain sight? 

Much of the debate over American health care centers on who should pay the bill. Far less attention is paid to those generating the bill in the first place. Much of America’s health care spending originates from physicians, of whom I am one, making decisions about what tests to order, which specialists to consult, which procedures to pursue, and whether a patient should be sent to the ER or admitted to the hospital. With that authority comes a responsibility not only to first and foremost care for our patients, but also to steward health care resources wisely. Yet somewhere along the way, American medicine cultivated a culture in which doing more became synonymous with doing better. Another test is reassurance; another consultation is thoroughness; another admission is caution. With taxpayer-funded government programs financing a substantial share of American health care, patients have less financial incentive to question costly tests and procedures ordered by their doctors. When patients are insulated from the true cost of medical care, the motivation to scrutinize its necessity becomes significantly diluted.

Ask the doctors themselves. In a 2014 national survey, nearly three-quarters of physicians called unnecessary tests and procedures a serious problem, while 72 percent said the average physician orders an unnecessary test or procedure at least once a week. In another 2017 survey of more than 2,000 physicians, doctors estimated that roughly one-fifth of all medical care was unnecessary — including nearly one in four tests and more than one in ten procedures. Even more troubling, nearly 71 percent believed that physicians were more likely to perform unnecessary procedures when they stood to profit from........

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