Fixing U.S. Healthcare Requires Curbing Physician Overtreatment and Overbilling Before Changing Who Pays
Source: Alexander Herbert, MD. "We Won’t Solve U.S. Healthcare Until Doctors Stop Overtreating." October 15, 2026. thefederalist.com
The Gist
The author, a hospital doctor, argues that people blame insurers for high healthcare costs, but doctors also drive costs by ordering too many tests, admitting patients unnecessarily, and billing for conditions more serious than they really are. He says switching to government-paid universal healthcare won't fix this unless doctors change their habits and face financial consequences for wasteful care.
Conclusion
America cannot achieve a more effective and fiscally responsible healthcare system, including through universal coverage such as Medicare for All, until physicians are held accountable for overtreatment, overhospitalization and upcoding. Changing the payer without changing physician practice patterns will not solve the problem.
Premises
- Physicians drive a large share of healthcare spending through decisions about tests, consults, procedures, and hospital admissions, and therefore carry a responsibility to steward resources wisely.
- Overutilization is widespread: surveys of physicians estimate about one-fifth of care is unnecessary, and most physicians say unnecessary tests and procedures are a serious problem and that doctors are more likely to perform them when they profit.
- Overhospitalization is common and costly: studies suggest many ER referrals and about one in five admissions were avoidable, and inpatient hospital care cost roughly $550 billion in 2022.
- Upcoding is systemic: federal settlements (IPC Healthcare, Prime Healthcare) and audits (42% of Medicare claims miscoded, $6.7 billion in improper payments, $1 billion in malnutrition overpayments) show physicians and hospitals inflating severity to raise reimbursement.
- Overutilization has several drivers: financial incentives, patient insulation from costs under taxpayer-funded programs, defensive medicine driven by malpractice fear, and physician complacency or incompetence, so it is rooted in professional culture and incentives rather than in who the payer is.
- Medicare for All would change only the payer, not these physician incentives and habits, so it would not reduce overutilization.
Assumptions
- Physician-reported estimates of unnecessary care are reasonably accurate and not biased by self-serving or hindsight perceptions.
- Overtreatment and upcoding are large enough contributors to total healthcare costs to be a primary obstacle to reform.
- Medicare for All or universal care would not itself alter physician incentives, for example through global budgets, payment reform, or utilization controls.
- Physician accountability measures such as compensation reductions for outlier overutilizers can be implemented fairly without harming appropriate care.
- Reforming physician behavior must come before, rather than alongside, changes to the payer system.
- The author's personal observations as a hospitalist are representative of the national situation.