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In 1996, a task force of independent healthcare experts recommended that doctors stop giving urine tests to people who did not show symptoms of a urinary tract infection. The test has “no benefit,” since even a positive result for elevated bacteria levels does not mean the patient is unhealthy, research shows.

The recommendation, like many others, was essentially ignored. Today the government spends about $1 billion annually for almost 15% of seniors on Medicare to get the test.

There are several dozen and possibly hundreds of such “low-value care” treatments – medical practices that have little or no clinical benefit, or which have a risk that outweighs their potential benefit, according to medical literature. They include Vitamin D blood tests and MRIs for mild lower-back pain. In all, more than one-third of Medicare beneficiaries receive a low-value intervention every year, costing taxpayers several billion dollars. 

“This is waste that comes from subjecting patients to care that, according to sound science and the patients’ own preferences, cannot possibly help them – care rooted in outmoded habits, supply-driven behaviors, and ignoring science,” Donald Berwick, who headed the Centers for Medicare & Medicaid Services (CMS) under President Barack Obama, wrote in a landmark 2012 study.

The contribution of low-value care costs to forecasts of Medicare’s possible insolvency has recently come to the fore, with Dr. Mehmet Oz sounding the alarm in the media and Congress. Oz, the head of CMS, recently launched a voluntary pilot program to reevaluate low-value care coverage.

But in June, the program drew unanimous bipartisan condemnation from members of the House Appropriations Committee, showing the political resistance that can stifle any attempt to reform Medicare, a bedrock program for 70 million seniors who often vote to protect it. Since 2010, the Health and Human Services secretary has had the power to ban 21 kinds of low-value care from Medicare coverage, but none have done so, including Robert F. Kennedy Jr. 

Despite the wall of resistance, think tanks and university researchers are continuing to call for Medicare reform. Absent significant reforms or eligibility changes, the 80-year-old program is expected to reach insolvency by 2033, according to the U.S. Treasury’s annual report. Medicare, which is funded by premiums and payroll taxes, will be an astonishing $60.4 trillion short of the money needed to pay benefits at current formulas over the next 75 years.

Options for making the program solvent range from raising premiums and deductibles to kicking people off health insurance entirely, according to healthcare researchers who spoke with RealClearInvestigations. A growing cohort of experts agree that reducing the use of low-value care is the most palatable option for cutting at least some of Medicare’s expenses.

“The luxury of covering things without worrying about what they cost – I think that’s gone for us in America,” said Dr. Vikas Saini, president of the Lown Institute healthcare think tank and a former faculty member at Harvard Medical School. “Given the affordability crisis, that cannot continue.”

Cascade of Unnecessary Procedures

In 2023, the government spent $848 billion on Medicare treatments, of which low-value care costs amounted to $5.9 billion – a number that has held steady over the past decade, according to a 2026 data book from MedPAC, an independent agency that advises Congress on Medicare policy. For every 100 Medicare beneficiaries, 74 low-value services were prescribed in 2023.

The true dollar cost is higher. MedPAC tracks only 31 kinds of low-value care but acknowledges that there are others. And low-value diagnostic tests often lead to a cascade of other unnecessary procedures, such as treating skin lesions that would have resolved on their own.

Part of the problem rests with doctors. Research shows the average primary care physician might be unaware that, for example, there is no benefit to screening adults for chronic obstructive pulmonary disease unless they show symptoms. As Dr. Saini put it, it’s something that only medical “nerds” care about.

“If physicians widely accepted it was low-value, they wouldn’t be doing it,” said Dr. Saini. “Doctors are super busy. They’re not spending their time poring over research studies. A small minority of people think about this stuff, but a vast majority of practitioners shape what healthcare actually looks like.” 

For doctors, determining the value of some treatments is not always clear-cut. Many treatments are only considered low-value under very specific circumstances based on a patient’s age, medical history and more, making it difficult to say when a treatment is truly pointless. 

The American Cancer Society has found that cervical cancer screening every three years is crucial for adult women, but not for women older than 65 who have had “adequate prior screening.” There is room for discretion involved. Is screening truly completely unnecessary for a 66-year-old woman? Is it possible to objectively define “adequate prior screening?” 

“There is this bit of nuance in the world of healthcare, that the value of a service depends on who gets it, by whom and where,” said Dr. Mark Fendrick, a University of Michigan health-policy researcher who has published extensively on low-value care. “It’s hard to distinguish high-value and low-value, and many third parties want to stay out of the area of the doctor-patient relationship.”

‘More Is Better’ Dogma

Doctors also fear being accused of malpractice if they do not order every possible test to determine the cause of a patient’s symptoms. Surveys show 85% of doctors believe that fears of malpractice accusations are one of the main drivers of overtreatment, and 59% also cited acquiescing to patient requests. 

“The more is better dogma in U.S. healthcare, which is not as present around the world, is one of the main driving forces of the use of low-value care,” said Dr. Fendrick. “A young person’s chief complaint is not, ‘I sprained my ankle,’ but ‘I need an MRI.’ Most people don’t need them. But if the patient wants it, the insurance is going to pay for it, and the clinician gets paid for it. It’s very hard with those incentives to not do it.”

Various medical groups have tried to reduce low-value care with little success. The American Board of Internal Medicine Foundation launched the Choosing Wisely program in 2012, in which 80 professional societies made a list of 700 treatments that doctors should be hesitant to prescribe. 

The creation of the list by doctors presented a conflict of interest: fewer expensive procedures meant less profit. Consequently, two-thirds of the list described treatments that doctors cannot make a profit from. The American Academy of Orthopaedic Surgeons focused its list on cheap supplements and a knee-cleaning procedure that no Medicare beneficiary had received in years. The surgeons did not list any orthopedic surgeries as overused, even though they are known to be one of the largest sources of low-value care.

Six years after the launch of Choosing Wisely, low-value care usage had declined only very slightly.

Peer-reviewed research would be a more objective way to identify low-value treatments, but studies on the topic are infrequent. According to Dr. Saini, that’s partially because researchers need funding from interest groups such as pharmaceutical companies that could see their profit margins eroded by reductions in low-value care. “The transmission of innovation and knowledge is biased by what you can pay for, and drug companies don’t have any incentive to ask if their drugs don’t work,” he said.

‘Insurmountable Barrier’

CMS’ efforts have not been much more successful. The agency announced an automated system in 2014 meant to reduce approvals of unnecessary MRIs, but it took four years to write the rules because Congress added numerous exemptions. 

The resulting administrative work proved too burdensome for CMS. The agency claimed Congress created an “insurmountable barrier” by over-legislating the program, making it impossible for any automated system to distinguish between MRIs that should and should not be covered. The program has been “paused” since 2024.

CMS’ latest attempt is called the Wasteful and Inappropriate Service Reduction (WISeR) Model. The voluntary program, launched in January of this year, will run in six states and require prior authorization for 13 services that are often covered by Medicare despite having no medical benefit. Doctors submit requests for the treatment, which are reviewed by an AI model that either approves the treatment automatically or flags it for review from a Medicare administrator.

The backlash was instant and often misleading. AARP told its 38 million members they would “need artificial intelligence’s OK for 13 devices and procedures,” never mentioning that a real person would review every denial. Georgetown University’s Medicare Policy Initiative, which advocates for improved Medicare coverage, claimed the WISeR Model was denying care more frequently than private insurance, ignoring that the model was reviewing only treatments that are known to be clinically unnecessary. 

The campaign worked. The 2027 draft federal budget contains a clause that would ban all funding for the WISeR Model, approved unanimously by the House Appropriations Committee. The budget still needs to be approved by the full House.  

Dr. Fendrick acknowledged that prior authorization can be burdensome, but said no attempt at restoring Medicare’s solvency will be easy.

“We need to find the money somewhere, and there is no interest in increasing the percentage of GDP we spend on healthcare, nor does any individual payer want to see their deductibles and premiums go up,” he said. 

Yet it seems the list of possible low-value care treatments is only growing. CMS is often forced to make coverage decisions shortly after new drugs are released, meaning evidence of their efficacy can be lacking. One study from 2024 found that just 16% of a sample of Medicare-approved treatments had been tested specifically for seniors. Another review found that only half of studies used to support Medicare coverage decisions involved randomized trials.

“Any effort to slow down the juggernaut of approving things by insisting that there be better evidence gets shot down pretty quickly,” said Dr. Saini. “It’s kind of mob rule.”

As Medicare lurches toward insolvency, the question is whether scientifically backed solutions like reducing the amount of low-value care will gain political support before more draconian fixes are required.