An op-ed in this weekend’s Baltimore Sun discusses the case of the alleged overutilization of stents at St. Joseph’s Medical Center. In the middle of it, the author says that this type of abuse should have been addressed in the recent federal health care reform legislation. I agree, but find it strange that the author implies that somehow a public option or some form of expanded Medicare would have done it. In fact, increasing government payment for health care services is guaranteed to increase overutilization. Only by putting control of health care expenses in the hands of health care consumers can we truly address the problems of doctors performing too many unnecessary health care services.

Health care payment systems that reimburse doctors for performing specific services (“fee for service” payment systems), such as Medicare, give doctors an incentive to perform as many services as possible. And when someone else is paying for your medical care, you have less incentive as a consumer to question whether that service is needed. So expanding a third-party fee-for-service health care system, which was what liberals fought for during the health care debate, would give doctors a larger incentive to perform care and consumers less incentive to question that care.

Consumer driven health care plans, such as health savings accounts, have the opposite set of incentives. Their use brings down the usage of health care as well as the cost without jeopardizing health care outcomes. As Peter Suderman of Reason magazine points out:

…there's strong evidence that they are the best known mechanism to achieve lower costs without sacrificing quality of care. A 2009 metastudy of high-quality research on consumer-driven plans by the American Academy of Actuaries (AAA) reported that "properly designed [consumer-driven health] plans can produce significant (even substantial) savings without adversely affecting member health status."

With traditional insurance plans, the only question is how much costs will grow each year. The AAA review of consumer-driven plans, on the other hand, showed first year drops of between 5 and 15 percent—putting total savings (when compared with traditional plans) between 12 and 20 percent. And although the evidence is less certain, the AAA metastudy even showed smaller cost reductions in subsequent years.

Critics of consumer-driven health care argue that, by allowing individuals to keep unused health care dollars, the plans create a financial incentive to skimp on preventive care. But the AAA report reveals this claim not only as baseless, but as the opposite of the truth: Every one of the studies reviewed reported a "significant increase" in preventive services.

Unfortunately, the federal health care law may undermine consumer driven care. I agree that the federal health care law was an ideal opportunity to try and fix this problem. Too bad it likely made it worse.