Drinking the Dartmouth Kool-Aid

Berwick again:

"While Berwick will be constrained by congressional directives and institutional rules, his large vision focuses on nothing less than revamping the delivery system from top to bottom. For example, when I interviewed him for my book Rx For Healthcare Reform, here’s how Berwick explained why he thought we could cut 30 to 40 percent out of healthcare spending without affecting quality:

The work of John Wennberg and Elliott Fisher at Dartmouth shows that the more intensive services are available in a community, the more that they’re used without effect on the quality of care. So supply drives demand. It’s a monster cost driver without value added.

This isn’t what most of the healthcare community (aside from primary care doctors) wants to hear. It isn’t what drug or device makers want to hear. And it’s a major reason why Republicans will oppose Berwick. But it is the message that all stakeholders need to absorb and take to heart if we really want to control costs and make good healthcare available to everyone."

http://industry.bnet.com/healthcare/10002286/berwicks-big-vision-will-make-him-target-in-bid-to-become-medicare-chief/

You can increase quality and reduce the cost of delivering some forms of care, but it has little to do with so-called "supply-driven" medicine.  It has everything to do with identifying what treatments work best for which patients in a given setting and continually improving your ability to selectively use the most effective treatments.  It is not easy and it it sure not a matter of adjusting the "amount" of care to the lowest per capita level or even standardizing treatment steps to the lowest cost per capita.