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Nation's Health-Care Crisis

April 20, 1985

The article on health-care costs was excellent and very comprehensive. Nevertheless, ordinary individuals, without thoughts of developing any of the rare serious medical illnesses, may agree that reduced health care spending can be achieved without a reduction in personal health care. I would like to present the following health-care situation, which makes health-care costs a more personal matter.

A middle-aged man sustained an injury where he almost lost his right foot. He was taken to a trauma center where excellent treatment by an orthopedic surgeon, vascular surgeon, and plastic surgeon saved his foot. He had several plastic surgery procedures including taking muscle from one leg to cover the other leg. During the interval between the plastic surgery procedures, he needed to be in the hospital. He required intensive rehabilitation for walking. He required casts and further plastic surgery over the next several months. Five months from the initial injury, he was able to walk although the ankle was stiff. He was able to return to his job which did not require prolonged walking. Not counting wages lost from work for a six-month period, his medical bills including hospital and physician fees, were in excess of $150,000.

An alternative approach to this case would be as follows. When the man arrived at the local emergency room, a team of physicians and administrative health professionals considered what costs would be involved in an attempt to save the foot and instead recommended an amputation. The amputation stump healed in two weeks, and he was fitted with a prosthetic (artificial) leg. (A middle-aged man can learn to walk with a prosthetic leg quite well in two weeks. There is usually no pain or discomfort associated with a below knee prosthesis). He recovered well and was released from the hospital after three weeks and returned to work in one month following the accident. The total medical cost was $15,000.

This is the dilemma that the people of the United States have to face. Do they want every attempt to save a leg? If so, they must be willing to pay. If this means increasing health-care expenditures, then so be it. If, on the other hand, people would rather spend more money on entertainment and consumer goods then they must be willing to accept a foot amputation as a cost-effective health treatment.

LAWRENCE S. MILLER MD

Glendale

Miller is medical director of the Glendale Adventist Medical Center.

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