The Money We Could Safely Not Spend on Health Care Is Beyond Belief

In retrospect, it was probably a mistake for President Obama to nominate a former Harvard School of Public Health professor and former Harvard Community Health Plan vice president as administrator of the Centers for Medicare and Medicaid Services (CMMS), formerly known as the Health Care Financing Administration, in Washington, D.C.

It didn't matter that Professor Donald M. Berwick, M.D., a longtime resident of Newton, MA, was a well respected pediatrician, that he had distinguished himself as a medical researcher, and that he had spent 19 years as head of the Institute for Healthcare Improvement, a nationally respected organization. His Harvard connection probably doomed him from the start with the Republicans in the U.S. Senate, where Dr. Berwick's nomination had to be confirmed.

The Senate Republicans are led by a man from Kentucky, Mitch McConnell, who has said his main job is to make sure Obama is a one-term president. They dug deep into Dr. Berwick's record, decided he was not sufficiently enamored of free-market, entrepreneurial health care, and closed ranks against his nomination. To avoid a nasty confirmation fight he might lose, Obama installed Dr. Berwick on the top perch at CMMS in a "recess appointment," meaning the president waited until Congress recessed and gave him the job by executive order. A recess appointment, however, is always limited in duration; Dr. Berwick reached his limit at the end of November, seventeen months after he started.

During an interview granted to the New York Times while preparing to leave Washington and return to Massachusetts, Dr. Berwick was asked what percentage of health care spending in the U.S. he considered wasteful? Between 20 and 30 percent, he said, defining waste as any expenditure that produces no benefit to a patient.

Dr. Berwick enumerated five reasons for what he termed the "extremely high level of waste" in the U.S. system: overtreatment of patients, the failure of health care providers to coordinate all the care given to a patient, the administrative complexity of the system itself, burdensome rules, and outright fraud.

If all that waste were to be eliminated, the federal government could save up to a quarter of a trillion dollars ($250 billion) on the Medicaid and Medicare programs!

Of course, it's unrealistic to think that all of the waste in our health care system could ever be eliminated. But billions of dollars in savings are there for the taking -- and should be taken, if we can finally get serious about critically examining how and what we spend on health care.

CMMS officials should be able to talk, for example, about Medicare reimbursements for treatments of dubious value to terminally ill patients without being accused of setting up "Death Panels." And they should be able to talk about the costs of defensive medicine, i.e., diagnostic tests ordered by physicians worried about protecting themselves from malpractice suits, without plaintiffs' attorney groups crying about the erosion of patient rights.

Ask any adult you know over the age of 40 who has good health insurance if he has ever been sent for a medical test that was, in retrospect, not needed or justified, and the chances are high the answer will be yes. My own personal favorite concerns the time I was given an ultrasonic scan of my carotid artery during a follow-up assessment for an episode of vertigo, a problem that had initially resulted in an extensive work-up, including a CT scan of my head, in the emergency department of a prominent Boston teaching hospital. The co-pay I had to make on that ultrasound was well over $200, which has served to prevent this memory from fading in my mind.

"Unnecessary" is a term that also covers a lot of the medical treatments routinely given to insured people today. Consider, for example, the report in the September, 2011, edition of the American Journal of Public Health, ("The Prophylactic Extraction of Third Molars: A Public Health Hazard").

Ten million third molars, or wisdom teeth, as they are commonly known, are extracted from approximately five million patients in the U.S. per year, at an annual cost of over $3 billion, yet two-thirds of those extractions are medically unnecessary, according to the author of the article, Jay W. Friedman, a retired California dentist.

If Dr. Friedman is correct, we could save $2 billion a year on wisdom tooth extraction surgery, and spare millions of patients needless pain, complications, and the unintended (and sometimes permanent) injuries to the jaw associated with this procedure.

To talk about such a thing would risk the ire of the oral surgeons who make a very good living yanking wisdom teeth from the backs of people's jaws, just as Dr. Berwick incurred the wrath of Mitch McConnell for once having dared to say something favorable about the national health system of Great Britain.