It is both conventional wisdom and factual truth that, unimpeded, American healthcare cost inflation will bankrupt the United States economically, educationally, socially, and politically in the not too distant future.

The inexorable upward trend line is unsustainable.

In 2009, I described six ways to save nearly $1,000,000,000,000 per year without serious harm, and with positive benefit to the public health.

They were:

1. Use intensive medical therapy instead of coronary artery bypass grafts and invasive angioplasty and stents for most established coronary artery disease.
2. Stop using PSA screening for prostate cancer in asymptomatic men.
3. Stop using mammography screening without clinical indications for women under age 50 and decrease its frequency for those over 50.
4. Sharply diminish use of CT scans and MRIs since they are mostly habitual art forms.
5. Decrease the practice of routinely administering untargeted chemotherapeutic false hope and real suffering to patients with widespread metastatic cancer.
6. Recognize death to be normal and endeavor to make it as dignified and free from pain as possible. Do not prolong dying to keep the revenue flowing.

I did not itemize the cost savings, but merely stated many billions or tens of billions for each item.

In 2012, writing in JAMA, Dr. Donald Berwick described six ways to save $558,000,000,000 to $910,000,000,000 per year.

They were:

1. Adopt known best care processes including proven patient safety systems and preventive care practices … savings $102 to $154 billion.
2. Coordinate fragmented care … savings $25 to $45 billion.
3. Stop overtreatment with unneeded antibiotics, surgery, and intensive care, especially at the end of life … savings $158 to $226 billion.
4. Simplify inefficient administration, rules, and billing procedures … savings $107 to $389 billion.
5. Price medical products and services transparently to cover costs and a fair profit … savings $84 to $178 billion.
6. Decrease illegal medical fraud and abuse … savings $82 to $272 billion.

Two different but similar ways of viewing how to cut medical waste, fraud, and abuse.

I would add today that the institutionalization of “defensive medicine” into “standard of practice” is also a nine-figures problem annually.

But every dollar not spent on medicine comes out of some other American’s pocketbook.

So, who matters most? The American nation, or the all-powerful American Medical Industrial Complex (AMIC).

For the past 50 years, when this battle has been engaged, AMIC has won every time.

It is past time to put the nation and its people first.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

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