I agree with you about the issue of needing to limit the over use of expensive high tech interventions that don’t have benefits to patients. I would even go further to say that we should limit (or at least slow) access to expensive interventions whose benefits are very small over lower cost alternatives until lower cost approaches have been tried.

However, many of the limitations of the current system make these arguments very tough for the public to accept. Without a strong proactive care system, the notion of watchful waiting or slowly stepping up intensity (and expense of care) is greeted with justifiable skepticism. In most care systems depending upon the organization or the providers to be organized enough, to give time for a trial of an old generic drug before switching to an expensive new one, would be foolish. They won’t call you back to see how it is working, so why should a patient want to go through the extra hoops of starting with anything less than the best, newest, and of course most expensive.

The same logic applies across the entire spectrum of services. If patients can’t trust the health care system to monitor and follow-up on their conditions why would they want to collaborate on limiting spending? In fact anything that mentions “limiting” access to anything is perceived by the public as a fundamental conflict of interest, as in cases where physicians get financial rewards for limiting expenditures.

Of course providers are even more conflicted on the other side – those expensive interventions are income for someone – but the real risks of unnecessary care are simply not well understood.

It will take a lot of work to (re) establish the trust needed to make “limits” an acceptable word.