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LYNN NEARY, host:

Many economists say one of the best ways to bring down health care costs in the U.S. is to stop paying for diagnostics and treatments that aren't necessary. But how do you determine what's not needed? According to a new poll conducted by NPR, the Kaiser Family Foundation and the Harvard School of Public Health, a slim majority of Americans don't want health insurers to limit care. And overall, Americans are hesitant about the government getting involved in treatment recommendations. NPR's Joanne Silberner reports.

JOANNE SILBERNER: Kerry Sailors(ph) of La Vista, Nebraska represents 55 percent of those polled. He does not want his insurance company or anyone else second guessing doctors. He's retired military and in the VA system. And his doctor had to fill out all sorts of forms to get him on a second cholesterol drug when the first one didn't work.

Mr. KERRY SAILORS: I think the doctor knows more about you, seen you, knows what's going on and is trying to make decisions to better your health.

SILBERNER: Ann Madson(ph) of Kalamazoo, Michigan represents the minority of those polled, who said insurance companies should not have to pay for an extensive treatment ordered by a doctor that hasn't proven to be more effective than other treatments.

Ms. ANN MADSON: Your primary doctor is only as good as the information he gets and the information that he studies and checks into. They're not infallible, they're people. They're humans.

SILBERNER: Madson's view that standards for doctors and hospitals could help make medical care most cost efficient, are shared by many experts who have been studying this issue for years. Economist Uwe Reinhardt with Princeton University says something has to be done.

Professor UWE REINHARDT (Economist, Princeton University): The idea that every American has the right to everything imaginable, whether it's shown to work or not and have someone else pay for that, I think it's just tragic, almost.

SILBERNER: If insurers pay for every little thing Reinhardt says…

Prof. REINHARDT: We'll have a lot of robust and healthy neurotic people 'cause we can't afford education.

SILBERNER: To avoid this scenario, the Obama administration got $1 billion set aside in the stimulus package for what's called comparative effectiveness research. It determines the value of different types of medical treatments. So given that a majority of Americans do not want insurance companies to be able to overrule their doctors, who should determine what's worthwhile? Kerry Sailors really doesn't want it to be in the government.

Mr. SAILORS: Why do I want some person sitting behind some desk that I'm paying $100,000 on my taxes for, to sit there and say Mr. Sailors doesn't need this. We don't care what the doctor says, he doesn't need it?

SILBERNER: Forty-two percent of Americans would trust a government organization to define appropriate treatment, compared to 55 percent who would trust a panel of experts from an independent scientific organization. Ten years ago, Great Britain came up with one way to do it. It created an organization called NICE, the National Institute of Health and Clinical Excellence. NICE gets a 70 percent approval rating. NICE chairman Sir Michael Rawlins says that's because committee members are academic and clinical doctors, nurses and pharmacists, not government employees.

Sir MICHAEL RAWLINS (Chairman, National Institute of Health & Clinical Excellence, Great Britain): Although NICE is, you know, heavily paid for by the government, it is independent. And that is actually valued by the government, too.

SILBERNER: Rawlins says government officials like it because they don't get blamed for controversial decisions. Meanwhile, the Obama administration is in the process of figuring out how decisions will be made and who will make them.

Joanne Silberner, NPR News.

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