Rational reform is not possible until we, as a nation, learn to demand effectiveness from medical treatment. If it doesn't work, Americans should not want it at any price. If more than 50 patients with a particular condition need to be treated to afford one beneficial outcome, Americans shouldn't opt for it.
That's not rationing; that's because an individual who does not have the medical or surgical intervention may be just as likely to enjoy such an infrequent meaningful benefit as an individual who does.
(In fact, I'd stake the cut-off at one benefited in 20 treated, but that's a matter of philosophy that needs a transparent discussion.)
We have the talent, the methodology, the ethic to place effectiveness at the top of our reform agenda.
Then we can rationally turn our attention to efficiency, equitable distribution, and quality of performance. The cost per capita of a health care system that takes effectiveness as essential, regardless of the suppositions, is a fraction (less than a third) of what we spend today. More importantly, physicians will be serving patients instead of being constrained by a system that is ethically bankrupt, and patients will be truly and well served.
And all that misspent money can be redirected to the major public health crisis in America, the macroeconomic crisis that deprives the growing numbers of unemployed, downsized, disaffected, disallowed and disavowed Americans the promise of a long and fulfilling life.
Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of "Worried Sick: A Prescription for Health in an Overtreated America," and "The Last Well Person."