An article by Brian Rank, M.D., in the New England Journal of Medicine on executive physicals-the Bentley of Cadillac care-is generating a lot of buzz in the blogs (here, here, here). The main message: more care is costlier care, but it's not necessarily better care. Rank writes:

Executive physicals also reinforce a related misperception - that costlier is better, that a $3,000 examination must be worth more than one that costs 1/10 of that amount. This is an indefensible idea that should not be promoted by the health care industry. Even as individual hospitals sell these services for exorbitant fees, gratuitously overusing our health care resources, our system as a whole is appropriately straining in precisely the opposite direction, toward cost-effectiveness, transparency, competition, and accountability. With its outrageous cost and unproven efficacy, the executive physical is almost a parody of the high-cost, low-return procedures that prudent companies rightly want clinicians to eliminate for other employees. [...]

As efforts to reform the health care system continue, the executive physical is a perfect example of what American medicine should be working to expunge: the expensive, the ineffective, and the inequitable. Perhaps if it didn't fail on all three of these counts, allowances could be made for it as a whimsical extravagance that satisfies certain people's need for exclusivity. As it stands, however, there is little to excuse it. As an industry, we can't expect to get credit for working to make health care affordable and effective for all if we're offering the "best" health care, for a price, to a few - when it isn't.