Part 2: A Reader Responds to “Getting Control of Health Costs – For Real”

To the Editor,

In order to achieve “Getting Control of Health Costs – For Real,” we must get real.

Controlling costs can't be achieved by citing anecdotal horror stories involving foreign healthcare systems, as does Dr. Smucker. These stories, without remarkable effort, could be outnumbered and overwhelmed by horror stories concerning our own system. (Don't get me started.)

And while costs could be substantially tempered by a single-payer system, advocated by Governor Dukakis and others, initiating such a system would require a difficult and costly internecine battle.[1] Nevertheless, many, like myself, believe that it is a battle worth waging.

In order to control costs even further, and at a more basic level, however, we must heed the words of a guy named George Lundberg, MD, who once observed,” “For the power brokers in our country, health care is no more than a matter of dollars and cents.” The clear implication, of course, is that healthcare involves a great deal more than simply dollars and cents, and that in order to control costs, more than costs needs to be considered.

I refer, for openers, to the heart of medicine, physicians – and how they are chosen for training. Traditional procedures employed in selecting candidates for medical education, as well as in assessing their functioning and ongoing education thereafter, are generally perceived as being state-of-the-art, and rigorous. They are neither. They are characteristically obsolete, inadequate to their task, and often misdirected in their objectives. Both patients and the profession suffer because of the shortcomings of these traditional evaluation procedures.

If we expect to have physicians who do not chronically and seriously inflate the costs of healthcare through drug errors, or through ordering unnecessary tests and procedures, by routinely engaging in “futile care” of moribund patients, or by engaging in Medicare fraud costing untold billions (recognizing that the few offenders here give their peers a bad reputation-ed) – to cite but a few serious cost boosters – we must begin to use more objective and effective assessment procedures to weed out those unsuited for the mission. Industry and the armed forces have done so effectively for a half century or more. Add the savings that can be realized through such a strategy to the monies to be saved by a single-payer system, and in the still famous words of Senator Everett Dirkson, from the 1960s, “A billion here, a billion there, sooner or later it adds up to real money.”

Only space limitations discourage me from introducing other fundamental stumbling blocks embodied in antique medical traditions. They are at least equally costly in human as well as in monetary terms. We must indeed get real and consider them as well, rather than limiting ourselves to the obvious debates about “dollars and cents.” If the basic considerations to which I refer are effectively attended to, it should be clear that many of the monetary concerns that plague us will as a consequence be greatly reduced.