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The clinicians and businesses that profit from expensive medical services and procedures have done a very good job of equating their profit centers with high quality care in the minds of voters and policy makers. RWJ's "New Way to Talk About the Social Determinants of Health" is a start toward making a case for paying for cost effective interventions to improve the health of all Americans, but we have a long way to go.

... page 6
"America leads the world in medical research and
medical care, and for all we spend on health
care, we should be the healthiest people on Earth. Yet on some of the most important indicators, like how long we live, we’re not even in the top 25, behind countries like Bosnia and Jordan. It’s time for America to lead again on health, and that means taking three steps. The first is to ensure that everyone can afford to see a doctor when they’re sick. The second is to build preventive care like screening for cancer and heart disease into every health care plan and make it available to people who otherwise won’t or can’t go in for it, in malls and other public places, where it’s easy to stop for a test. The third is to stop thinking of health as something we get at the doctor’s office but instead as something that starts in our families, in our schools and workplaces, in our playgrounds and parks, and in the air we breathe and the water we drink. The more you see the problem of health this way, the more opportunities you have to improve it. Scientists have found that the conditions in which we live and work have an enormous impact on our health, long before we ever see a doctor. It’s time we expand the way we think about health to include how to keep it, not just how to get it back."

Hope Part II explicitly addresses the multiple perverse incentives in today's health care system that drive its hyper-inflation, and how those incentives require a fundamental realignment if costs are ever to be controlled. Setting goals without realigning incentives will just be happy talk--it will get us nowhere. Sorry to be so brutal about this, but it's the brutal truth.

David Riemer, Director, Community Advocates Public Policy Institute, Milwauke, WI

Why not include a value calculation into the decision making process? Results of these calculations could be used as incentives/disincentives, but there are other options.
It's an over-simplification (but perhaps not so far off?) to say that roughly 1/3 of what we pay for (U.S. health care spending) provides net benefit, 1/3 provides no net benefit (or negative value) and, for the remaining 1/3, we don't know whether there is a net benefit.
Why do we use public dollars to pay for the 1/3 that provides no value?
We should be able to improve health, give patients what they both want and need at lower cost. How much of the "want" is driven by misinformation?

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