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Paying for Health

June 26, 1988

Your column on health-care costs accurately described the impending astronomical rise in health-care costs. But it failed to address the principal cause, which is the extreme overutilization of health-care assets for a segment of the population that gets little, if any, benefit. I am a family physician with a special interest in geriatrics, and I am mystified by the elaborate and extremely expensive care we give the elderly while virtually ignoring the young, who could benefit with a lifetime of good health with minimal expense to society.

The point you failed to see is that health-care delivery is primarily physician-driven. It is physicians who make the diagnoses, order the care and profit along the way. Society has only recently developed a system of cost control in Medicare, through limits on hospital payments, and in private health care, by using prepaid health care provided by health maintenance organizations and other medical groups.

We will also need to change the way we treat our elderly, many of whom want medical care to extend their lives only if we can also provide them with time that they can enjoy. If the best we can offer is slow decay in a nursing home, most of the elderly would opt for minimal intervention and a peaceful death.

Sadly, the patients who today receive the most extreme care are usually residents of nursing homes whose families have abandoned their medical-care decisions to nursing home personnel and their attending physicians. The physicians tend to do everything for everybody.

They have two incentives: first, avoiding malpractice claims with heavy doses of defensive medicine and second, personal gain, which is determined by the number of times the physician gets to see the patient. Both of these are obviously not in the best interests of the patient or the society which has to pay for it.

We need to carefully examine our current medical practices to provide only those services which will truly benefit our patients. The current debate over euthanasia reflects a growing frustration of our aging population with the financially crushing and frequently useless medical care we provide them.

We must design a system where the patient who is ultimately the consumer has the absolute choice in determining the level of medical care he or she will receive. We and society must accept those choices while recognizing that our role is not to prevent death but to enhance life.

HARRY ZELIG

Toluca Lake

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