The problem of finding which medical treatments work

One thing everyone agrees on is that our economy cannot sustain the amount of money we spend on healthcare. That was clear even before the Wall Street meltdown, and it’s even more true now. The United States spends 16% its gross domestic product (GDP) on healthcare, a figure half again that of the next highest spending country (Switzerland, at 11%). Most other European countries spend 9-10%. We also spend much more per capita than anybody else. (These figures are from 2003, but little has changed since then — if anything, it’s worse.)

Not only do we spend more than anybody else, but by many measures, as a society we get much less for our money. That is, in spite of our high healthcare bills, the United States does not compare well with other countries in many measures of health.

What’s to be done? How can we find ways to spend less on healthcare but get better value for our dollar? One answer is that much of the money we spend is on unproven or even worthless treatments. Many authorities advocate we establish an independent agency of some kind to evaluate which treatments work and which ones don’t. Britain already has such an agency, called the National Institute for Health and Clinical Excellence. The way it works is that patients and physicians are free to use a non-approved treatment, but insurance won’t pay for it. As you can read in the linked article, there are some vocal opponents to the agency, something probably inevitable. But in the words of its director: “We are not trying to be unkind or cruel. We are trying to look after everybody.”

Opponents of such a concept complain this represents rationing of health care, because inevitably it would mean that patients won’t get all they may want. This is true, but in fact we’re already rationing care; we just use a more insidious method. Anyway, what else are we to do? There is simply not enough money, especially now, to pay for everything. It’s time we recognize that. An independent evaluation agency of this sort would make the decision-making process transparent and fair.


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