The Price We Pay: What Broke American Health Care--and How to Fix It

by Marty Makary

To try to address this gap, I set up a meeting with midlevel Medicare leaders. They liked the idea of setting boundaries of acceptable variation. They referred me to their website, which lays out their standard process for proposing a new quality measure for Medicare to consider using. I noticed that one of the requirements was that any proposed new measure be supported with multiple published articles proving that the measure was evidence-based. That’s a nice idea, but a narrow way to look at quality improvement. No one would ever do a trial comparing the outcomes of surgeons who take two versus three blocks per case. For one thing, a trial subjecting people to three blocks per case would be unethical. I gave up on the website.

When governance goes wrong!