The mystique of health care


Who do you believe pays for the rising cost of health care? Insurance companies, employers, the U.S. government? You are wrong. We all pay -- through higher insurance premiums, reduced wages, higher taxes, higher prices.

As the daughter and sister of physicians, I have spent a lifetime observing the medical profession. Our culture has shrouded it in a mystique that is seldom justified. Now, we are forced to ask: Can we afford it? And the cause of our dilemma may be your unquestioning acceptance of both the care and its cost.

America's health care system, already the world's most expensive, is getting more expensive each year. Why? The population is aging. Medical technology has become vastly more complex and is more widely used. The government isn't paying its share. And malpractice lawsuits have gotten out of hand. Yet, the major cause of increased costs may be that Americans are not very astute consumers of health care.

There is little the average person can do about an aging population. Getting the government to pay more and reforming tort law will take time because both involve the slow-moving legislative and judicial processes. You can adopt a personal life style that reduces health hazards.

"A lot of people believe health care is too complex. They can't possibly know the difference between good value and bad value," says Dr. Howard Bailit, vice president of health care management at Aetna Life & Casualty.

A sure-fire sign of a good patient/provider relationship is a free flow of information. "That means, when an operation, medication or test is prescribed, a patient should be able to talk to his doctor about the chance of success, the possibility of adverse side effects and, within reasonable estimates, how much it will cost," Dr. Bailit says.

Few health care encounters require snap life-and-death decisions. More often, decision-making involves chronic illnesses or conditions that allow time for physicians and patients to discuss treatment alternatives and their likely outcomes.

Physicians are highly trained. But, they cannot predict how their patients will react to their advice and counsel. As a patient, you must take the lead.

A word of caution. Don't be alarmed if your doctor doesn't have all the answers. Particularly with certain chronic ailments like arthritis, impaired vision and chest pain, the best course of treatment isn't always clear. Often in these cases, radical procedures are little more effective than less expensive ones. Each year, for example, about 80,000 Americans get a carotid endartectomy, a procedure that clears clogged neck arteries and costs about $9,000. Although the treatment is designed to prevent strokes, no one really knows for sure how successful it is.

Now, a growing core of physicians is pushing for more comprehensive collection of data to determine the effectiveness of medical procedures.

One creative effort to help consumers make better-informed decisions on treatment uses interactive video discs. For example, a video disc presentation assesses the risks and benefits of prostate surgery, includes interviews with people who have had the operation and confronts the patient with the possibility that impotence and other complications may occur as a result of surgery. So informed, some people, in order to avoid the risk of surgery, choose to live with the inconvenience of waking up at night and not sitting through an entire movie.

Fortunately, making these kinds of decisions is getting easier for consumers.

Meanwhile, as data on the outcome of treatment methods bring more science to the practice of medicine, consumers still need to practice the art of asking good questions. By doing so, greater value can be wrung out of the U.S. health care system, which still has more to offer than any other health care system in the world.

1990 Los Angeles Times Syndicate

Times Mirror Square

Los Angeles, Calif.90053

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