‘Medical Costs: Out of Sight’

I submit that the reason that health care costs appear to be out of sight is that the delivery of health care has been subject to regulation based on well-intentioned, but blind, thinking. For example, the shift in treatment patterns from reliance on expensive in-hospital procedures to reliance on much less costly, but nonetheless effective, outpatient modalities is well-documented.

One would, then, expect to see exactly the overall drop in expenditures on in-patient hospital care and the rise in the use of outpatient services that your editorial condemns. Why do you imply physicians are abusing the system, instead of acting appropriately? Perhaps your well-intentioned concern for the 38 million people without health-care coverage has clouded your vision. I am afraid that, in this era of extreme concern over budget deficits, your editorial will contribute to the possibility that government will blindly assume over-utilization and deny needed care in the name of cost containment.

You are right to question how we as a nation can spend the amount we do without achieving the coverage or outcome of other industrialized nations. However, we need to divide this concern into two parts. First, universal coverage won’t be achieved through cost controls alone. Both the public and private sectors must cooperate in finding ways to finance the delivery of appropriate health care to all Americans. Second, that effort will not succeed unless we find the answer to the bigger issue, namely, what are the commonly accepted norms of treatment that produce the desired outcome in any given case? That is, how do we distinguish appropriate expenditures from inappropriate ones?

Unfortunately, in my experience of over 18 years as a health-care attorney, I have found that most regulatory focus on quality of care has been a focus on record-keeping and not a focus on the outcome of the care being recorded. To end our concern over health-care expenditures, we must begin a dispassionate and objective review of medical procedures and outcomes. Once we know what our objectives should be, we can use regulation and funding initiatives to rationalize our health care delivery system.

MICHAEL J. TICHON

Los Angeles