Technology in Health Care: Reconsidering the "Wasteful" and "Unnecessary"

I think it's time for expert and amateur commentators of health care reform to get more specific about "wasteful" and "unnecessary" health care spending. What, exactly, is waste in the context of human care? Where do we find it? How do we extract it from our health system? Medical care is currently too expensive to achieve high-quality, universal care, so there is little doubt among reputable economists and health policy experts that overall cost reduction must accompany efforts to expand coverage and accessibility. Fortunately, the Obama Administration's first steps toward health care reform suggest an understanding that science and technology are not necessarily the sources of "wasteful" or "unnecessary" care, but rather the tools with which we can increase efficiency of care and reduce costs.

Medical technology is often identified as a primary source of overspending in our health care system because it is estimated to have contributed to 50% of recent growth in health care spending. A problem here is that the growth in health care spending has become synonymous with the excessive and the wasteful in health care spending. Economists and other commentators argue that we must cut out unnecessary costs by targeting the drivers of cost growth. This is faulty logic that, if acted upon, could be disastrous. Viewing the progress of innovative technologies under this lens of cost reduction is precisely upside-down. Not only do attempts to control adoption and use of innovative medical technology carry severe, unintended consequences for the overall quality of health care, but incentive-directed technological innovations, directed toward hospital and physician care cost reduction, can substantially reduce overall costs in the near-mid-term, while assuring improved quality in the long-term.

Technological innovation is inseparable from the cost-coverage trade-off in health care because it plays a common role in comprehensive data collection and efficient information consolidation and management; together, these lead to systemic cost control and allow sustainable expansion of coverage. President Obama's early action to invest in the collection and management of health data and information is an important first step in moving medical care to a more efficient, precise process that is better for payer, provider, and patient.