A great deal has been made of late of evidence based medicine which is the scientific and statistical evaluation of the costs and benefits of medical treatments. Wonks Anonymous finds it hard to be against evidence based medicine, particularly when he reads stories about the pervasiveness of costly, painful and unnecessary treatments like this one on invasive cardiology. All medical treatments are painful and time consuming and, if something doesn't really do any good, why go through with it?

Of course it gives Wonks Anonymous some cause for doubt when he is told that the apostles of evidence based medicine in our brave new efficient health care system will be health insurance companies.

Because organizations staffed by actuaries, MBAs and accountants have all the skills and training needed to evaluate complex treatments and epidemiological studies. If doctors had wanted to learn these things they would have gone to business school.

Still Wonks Anonymous does see one vast area of medical treatment that would benefit by a thorough scientific evaluation. Which area would be the growing collection of health plans that seek to alter patient and doctor behavior by increasing out of pocket costs for treatment or by exclusions of various treatments and diseases from coverage.

Because, if there is one thing that Wonks Anonymous knows as an economist, costs have strong influence on human behavior. Health plans that change the costs of treatment change how patients and doctors will approach their health.

Is it, for example, wise to write health policies that impose steep costs on individuals seeking basic primary care? That would be the high deductible policies that pay for nothing until the subscriber incurs expenses over $5,000. What about policies that refuse to pay for mental health or addiction treatment?

Wonks Anonymous thinks not and he can tell stories where patients avoid visits to the doctor only to wind up, after some delay, in the ED. Stories where the ED visit leaves the patient with a chronic and disabling illness that could have been avoided with timely care. He can think of stories where money saved on treatment of addiction is spent on traffic accidents and liver transplants.

Wonks Anonymous does not, however, know if his stories are significant and he would like to see hard evidence for or against.

There one health care provider/health insurer that is ideally positioned to study this issue. Kaiser Permanente has excellent medical records and a top notch department of research. It also offers a wide variety of the latest medical plans - high deductible and so on.

So, if anyone out there from Kaiser is listening, shouldn't you folks be studying this? Dr Garfield would have wanted to see the results.