Health-Care Increased With Costs

As a health economist I am morally obligated to respond to “Plan for a Healthier America” (Letters, March 3). Although some of the points raised are valid, the writer’s basic attitude is based on misconceptions and errors.

Trudy Schwartz claims that the 900% increase in health-care costs in the last 20 years have been without a commensurate increase in the quality of care. Against this, I have two points: One, there has been a dramatic improvement in the quality of care (supported by the large drop in infant mortality and the large increase in average life expectancy). Two, more than 50% of the increase in health-care costs is due to a change in how our society lets people die. Health providers, in response to society’s demands, now continue to do “everything possible” in the face of imminent death, whereas they used to let such individuals die in peace with as little pain as possible.

Ms. Schwartz’s proposed criteria for a new system are unrealistic. Her goals would be impossible to meet without bankrupting the system. She seemed to dodge the real question: How do we change the way we let people die so that it doesn’t cost so much?

In my extensive relations with the health-care industry, almost everyone I have met has the patient’s well-being as their primary interest. I will not claim that all health-care personnel are so altruistic, but then are are bad eggs in every basket.

CIARAN S. PHIBBS

UC, San Diego