Quick background here: "Right now, health care is more evidence-free than you might think," Orszag writes. "And even where evidence-based clinical guidelines exist, research suggests that doctors follow them only about half of the time. One estimate suggests that it takes 17 years on average to incorporate new research findings into widespread practice." And that gets to Orszag's broader take on controlling costs in health care: If we can get doctors to stop doing the stuff we don't need, we can control costs without rationing in a way that harms anybody's care.
Of course, defining the stuff we don't need is more difficult than it sounds. And when evidence-based medicine became something Democrats wanted to do, Republicans decided it was something they opposed. Using research to decide what works and what doesn't is rationing, you know.
Orszag sees medical-malpractice reform as a way to get around this debate. Instead of protecting doctors from lawsuits by capping damages or limiting the ability of plaintiffs to sue, you could protect them by charging the American Medical Association or the Institute of Medicine with creating standard lists of best practices and then providing immunity to doctors who can show they followed them. That's easier said than done, but if you could manage it, it would give doctors a reason to follow the best practices and, in theory, drive down overall health-care costs. That would be much more effective than just attacking malpractice suits, which aren't a large contributor to spending and are often quite warranted.
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