The Power of Better Information

In a provocatively written piece "Technology and the power to say no is real health reform" http://bit.ly/9JOZ7v, Dana Blankenhorn writes that real health reform involves saying no to the sellers of useless medical care and no to patients who refuse to make behavioral changes that would improve their health. By saying no, he means that we must stop paying for health care that doesn't work and for health care for people who don't deserve it.  I agree with his first claim and disagree with his second.

What's great about the article is the very strong case he makes for curbing the growth of healthcare costs by attacking it at the source. The growth in health care costs does not originate with the usual suspects - poor prevention, big government or with overpriced health insurance. Our problem originates with the sellers of health care - especially specialist physicians, high tech hospitals, medical device manufacturers and pharmaceutical companies. The sellers of high cost health care have been dipping into our wallets without our permission for many decades, and it is time we figured out how to make them stop.

It's the sellers of high tech health care who are causing the big hikes in health insurance premiums. It's not that we don't need some of the technologies they sell. It's that we have very little information about what we need and what we don't, and they aren't telling. They're too busy selling. 

So we need more information - comparative information - that tells us which interventions work well and which interventions are just dressing on the cake.  The Federal effort to fund better comparative effectiveness research is exactly what is needed. Once we have that information, we need to use it. We need to find the power to say no to some of these useless technologies and interventions. We need to aquire the the power to say no to the sellers of useless health care. We need to eliminate insurance reimbursements for health care that doesn't work. That's what we'll need if we want to see an end to 39% hikes in health premiums http://bit.ly/9uNKw6.

A recent article in the Journal of the American College of Radiology shows that in one large health care system in Washington State, approximately 1/4 or 26% of all referrals for diagnostic imaging services were not necessary. See a story on this study here:  http://bit.ly/a6zmev.  Many of these diagnostic procedures - x-rays, MRIs and CT scans - are very expensive, and we're paying for these procedures in our health insurance premiums. Why are we doing that and why don't we stop? Someone's got to start saying no. Dana's right about that.

That said, I don't agree with Dana that we must also learn how to deny care to overeaters, smokers and drinkers. The worst of our national health behaviors are undoubtedly killing our bodies and our wallets. However, the most effective strategies for defeating these behaviors and their outcomes - obesity among the worst of them - are not known.

We do know that obesity runs in geographic clusters.  In some regions of the country, people are overweight because there is no fresh food to be found, for miles. In these "food deserts," residents dine on fast and convenience foods. Obesity rates have skyrocketed in these areas over the last several decades. Effective strategies are needed to eliminate the deserts, not to penalize the people. To date, however, very little research has been conducted on what can be done and what might work to reduce desert-induced obesity.

Obesity also runs in social networks, and this finding has only been available since the publication of Nichoolas Christakis' groundbreaking article on that subject in the New England Journal of Medicine three years ago:  http://bit.ly/bHUmBL.  More information is needed to understand how social networks can be used to improve diet and exercise.

Interrupting the geographic and social determinants of obesity may be better than penalizing the elderly person who acquires diabetes after a lifetime of cheeseburgers.

But we need better information about what works and what doesn't. That's power.