Underuse and overuse take place in the same communities for identical services. Meanwhile, much attention is focused on medical errors, which account for a tiny percentage of the adverse outcomes to care, he said.

He warned that many preconceptions about health-care reform are not supported by the research. For example, prevention, while a good thing, does not save money when applied across the general population. The savings come when specific preventive care is targeted to the people most at risk for a condition. So taking steps to prevent asthma attacks in children with mild asthma, in one study, cost $31 for each symptom-free day achieved. But the program for those with severe asthma saved $2.92 for every symptom-free day.

If Social Security is "the third rail" for the economy, as some have said, overuse of health-care services is "radioactive," Chassin said. But consumers see efforts to curb overuse as a benefit that's being taken away. That must change for meaningful health-care reform.

He believes "we do have the knowledge and the tools. We can create consensus-based guidelines when something is not appropriate." Consumers and doctors need to know why it's better, sometimes, for a doctor to say no. After all, he added, "insanity is doing the same thing over and over again and expecting different results."

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E-mail: lois@desnews.com