How Can Cost-Effectiveness Information Help Control Unsustainable Growth in U.S. Health Care Spending?

TO THE EDITOR:

It is admittedly time for the nation to openly discuss cost-effectiveness in health care; therefore, the proposals from Garber (1) and Wilensky (2) are timely. Being a solo practitioner, I view this type of “top-down” policy as similar to some of the previous mandates that may have led us to this situation.

Although I agree with most of the principles in theory, I have reservations about how these might affect community-based clinical practice. First, if such a program is ever implemented, every practice will have to rework every insurance contract that each physician currently has, leading to substantial (unfunded) expenses, which hurt small practices the most. Physicians may just opt out of participating in insurance plans or Medicare if they are mandated to rework these …