The Affordable Care Act controversy rages on. In this week's BMJ, journalist Jeanne Lenzer says the basic assumption that US people don't have enough health care is misleading and in reality, Americans have too much - and that unnecessary care costs an estimated $800 billion per year. 

The article arrives as an international conference named 'Preventing Overdiagnosis' was announced for September, 2013 in the United States, hosted by The Dartmouth Institute for Health Policy and Clinical Practice, in partnership with the BMJ, Consumer Reports and Bond University of Australia.

The U.S. medical establishment prides itself on saving everyone it can.  Some contend that overly aggressive treatment is estimated to cause 30,000 deaths among Medicare recipients alone each year, while unnecessary interventions are estimated to account for 10-30% of spending on healthcare, or $250-800 billion annually. Examples range from the overuse of screening tests, commonly called defensive medicine, since it is needed to ward off spurious lawsuits, and imaging technology to questionable surgery.

The doctors contend overtreatment leads to patient harm but the onus of the modern movement is bringing down costs so that the government can afford to get into the health care business. Currently, Office of Management and Budget estimates to provide the high-end treatment people get, even when the prognosis is not good, estimate tens of thousands of dollars in new taxes for citizens.

Because health care has become a political football, rationalizations about overtreatment are receiving significant attention from the American media and politicians. The doctors in the article identified several reasons for overtreatment, including malpractice fears, biased research, patient demand, and financial conflicts of guideline writers in the modern, government-mandated 'teach to the protocol' environment. Several speakers highlighted the way physicians are paid and trained in the US as central factors, and nearly 80% believed that more radical payment reform is necessary to reduce the problem meaningfully.

But as these initiatives begin to move forward, they will face formidable challenges from the medical professionals in the healthcare industry (who don't think they are overpaid) and the general public who fear that the overtreatment argument is just laying thee groundwork to ration care, reports Lenzer.

Advocates of reducing treatment disagree. "Rationing means that you are limiting necessary care. What we are proposing is limiting unnecessary care – harmful care," argues Dr Diane Meier, Professor of Geriatrics and Internal Medicine at Mount Sinai School of Medicine.

Jerome R Hoffman, Emeritus Professor of Medicine at the University of California, Los Angeles, said: "There's already lots of rationing in healthcare; wouldn't it be better for us to decide what should be available, based on what's best for our health, rather than having insurance companies decide, based on what's most profitable for them?" U.K. NHS patients and doctors disagree that government should be deciding who to save and claim it is just a 'death pathyway', since some claim they kill 130,000 patients per year rationing care, while others contend that resources wasted on unnecessary care are better spent treating and preventing illness in the underinsured or uninsured. But the underinsured and uninsured should not exist under the Affordable Care Act.