The Wall Street Journal editorial page published a piece this week that inaccurately describes how to achieve the highest quality care: spend a lot of money. According to the WSJ, the only way to spend less is to ration care. That's not true.

It's important to remember that more spending on care doesn't mean better care. It means more services and/or higher prices. Former George W. Bush appointee Katherine Baicker shows this in her Health Affairs article (with Amitabh Chandra) that discusses the inverse relationship between cost and quality. (See their chart here.) Read that again—not a researcher for Michael Moore, a Bush appointee. Dr. Baicker has worked at Dartmouth and is currently a professor at Harvard.

As Dr. Sandeep Jauhar, a cardiologist and author, wrote in The New York Times recently, "...a doctor who owns a scanner is seven times as likely as other doctors to refer a patient for a scan. In regions where there are more doctors, there is more per capita use of doctors' services and testing. Supply often dictates demand." We know from Atul Gawande's work that this doesn't mean better care.

The WSJ laments countries that spend less are using rationing. While some countries do this, many do not—especially multi-payer systems. We have a multi-payer system in the United States, and none of the mainstream health reform proposals would scrap our multi-payer system. We don't know exactly what our reformed health care system would look like, but there will be choices and options, different levels of coverage. But everyone will have coverage. Right now, being uninsured is a crude (and cruel) form of rationing.

We would like—-and would think that the Wall Street Journal would like—to see our health care more like high-quality, low-spending states. Purple states such as Iowa and New Hampshire are among the best in terms of cost and quality.

The Commonwealth Fund published Aiming Higher: Results from a State Scorecard on Health System Performance two years ago, which described the highest performing states in five areas: access (the opposite of rationing), quality, avoidable hospital use and costs, equity, and healthy lives. The results? States in the top quartile of all five measures tend to cluster together. See exhibit 2.

The tough question is how we get there. As Joe Antos from AEI said on NPR, it's a cultural issue. We learned that in our case studies published in March. Physicians need to be respected, trusted, and paid on time, and in turn, need to trust organizations like the Baylor Best Care Committee. With the spread of accountable care organizations, developed with incentives from new payment methodologies, more Best Care Committees could spring up. It's a model of federalism: while organizations like AHRQ help guide national priorities, Best Care Committees can give it a local—but still evidenced-based—flavor.

If the U.S. spent nearly twice the OECD average on health care per capita but had the best system with the highest quality, I'd be putting in an application to blog about rock music. But that's not the case. The WHO ranks us 37th in the world.

The one area where we are highly ranked is responsiveness. That's a good thing—if you have the money to spend, you can have whatever you want done to you (you know, with a few exceptions). That won't change after all Americans have health coverage. On the contrary, currently insured Americans will reap the benefits of a better functioning health system: higher quality at lower cost.