What is wrong with American medicine

Sunday, December 30th, 2012

Joel W. Hay explains what is wrong with American medicine:

Suppose you went to your local car dealership and they said they had a great deal on a new car model, the “IMRT.” Then they told you that the IMRT costs 20 times what the older model costs and probably isn’t any better. You’d immediately walk out the door. But if you are a Medicare or Medicaid patient with prostate cancer and the “dealer” is your local urologist, and the IMRT is “intensity-modulated radiation therapy,” it sells like hotcakes when it is 20 times more expensive than prostate surgery and provides no better outcomes for a majority of patients.

IMRT is the poster child for what is wrong with American medicine. The 20-fold higher price doesn’t matter much to the patient because it’s mostly covered by Medicare or other insurance. However, the urologist that prescribes IMRT can get hundreds of times as much from Medicare as they would from the more conservative treatment approach of “watchful waiting” – monitoring disease progress through routine office visits. As UC San Francisco urologist Dr. Cooperberg said, “Doctors do what they’re paid to do. If you tell them they can earn $2,000 for surgery or $37,000 for IMRT, what do you think will happen?”


By federal law Medicare is not allowed to evaluate the cost effectiveness of alternative drug treatments. By federal law, the Obamacare center for outcomes evaluation (PCORI.org) is forbidden from evaluating the costs of alternative health care treatments.

This is why we are facing a $60 trillion unfunded liability for future Medicare costs and why all of the increases in average worker compensation over the past two decades have been sucked away by increased health care costs.


  1. Jake says:

    I found the same true about eyesight, optometrists, and glasses. The system pays for glasses, and optic shops push big profits, but nobody cares about my damn eyesight.

    My vision went from 20/20 in my teens to -4.00 in my 20′s. Down half a diopter every year or two. And every time it’s a few hundred bucks for lenses, frames, office visit, whatever.

    Then a year and a half ago I was introduced to a vision rehab clinic (Alex rocks!). Now I’m down to a -2.25 (almost half) and still improving.

    Optic shops make no money teaching people that they don’t actually need glasses. Insurance pays. We get shafted.

    A shoutout to Alex.

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