Cut Hospital Costs and Doctors' FeesAn article attributed...

SATURDAY MAIL BOX

May 29, 1993

Cut Hospital Costs and Doctors' Fees

An article attributed to the New York Times News Service and printed in The Sun and The Evening Sun May 11 states that Medicare pays for the health care of 32 million elderly and 3.6 million disabled people. Apparently, the new federal administration seeks to restructure the health care system in a more comprehensive, sweeping and ambitious manner.

Repeated attempts to provide proper medical management have been made since the 1930s. Any number of alphabet agencies aimed at giving therapy to the rich and the poor have been devised.

This era, inaugurated by the advent of the anti-bacterial compounds, has been extended by the numerous examples of highly technological forms of diagnosis and treatment.

The linchpin of any drive to provide adequate medical care for all Americans must be a reduction in total cost. Equally important is that the freedom of patients to choose doctors must be protected. Rationalization to adopt these ideas will be difficult.

James Stacey, who works for the American Medical Association, has presented his thoughts about reduction of the projected $211 billion in federal outlay in 1993 in a recently published book:

* If patients would pay for a part of their care, the use of out-patient and hospital facilities would decrease dramatically.

* Cost-sharing and deductible limits should be linked to income.

* Health maintenance organizations should be used in preference to hospital emergency rooms as they are much less expensive. The HMO also affords the opportunity of seeing the same doctor if return visits are necessary.

* Inasmuch as certain cancers have a notoriously poor prognosis at the time of the first visit, patients should not be subjected to extended surgical procedures or prolonged chemotherapy once the diagnosis has been made.

* Much of the terminal care given in hospitals may be given at home or in a hospice.

* Cutbacks may be made in hemodialysis, as many patients with kidney failure have so many complications that their lot is most unhappy.

* Coronary bypass procedures have become commonplace in medical practice. A study in 1988, however, suggested that 50 percent of those 200,000 operations might have been unnecessary.

* At the moment, further installation of high-cost equipment in hospitals should be stopped.

Unrest is found not only among patients as to who will pay for unexcelled care but also among doctors. To many of them the cost of malpractice insurance is more than unreasonable and the reasons are quite clear. Multi-million dollar claims and payments are now commonplace. The practice of defensive medicine is wasteful.

Most human beings long for eternal life or at least for a prolonged period of good health. As the alchemists brewed their elixirs to capture immortality, so Western civilization is rightly seeking to extend healthful years by its new medicines and technology. Those individuals who are seriously ill and about to die, however, should not have a few days or weeks added to their lives by the use of ultra-expensive therapy.

The money spent in these endeavors would better be used to care for the young and to feed the hungry. Society, as a whole, however, is reluctant to acknowledge that life should be permitted to end in many instances without heroic, high-priced methods, if a third party will cover the cost.

In general, the public does not realize that money recaptured above and beyond the actual premium must be taken from some other source. Higher premiums will result for all insured.

At the present time, the ''working poor'' and a substantial number of middle class families would face tremendous financial difficulties if they had to be hospitalized for any period of time. Few of the laity realize that the basic cost of room, board and ancillary services approaches a national average of over $700 per day.

In a country where medical care is the best which can be given, many are denied such treatment because of the inability to pay. The answer does not reside in increasing the amount allotted, as this course has experienced repeated failure.

Reduction in the cost of every item in hospital life along with reduction in physician fees is perhaps the only source of correction remaining. More money allotted and a new acronym will prove worthless in solving the health care problem.

Joseph M. Miller, M.D.

Timonium

Toilet Bowl Logic

Investing money on education is like flushing money down the toilet, if we are to believe the recent article by Douglas Lamdin ("Money and Schools," April 22). Mr. Lamdin sets up his own straw man and then proceeds to disassemble it with misleading information.

No credible educational reformer asserts that money, no matter how spent, will result in the improved quality of schools. Money can be spent wisely or poorly. This is a trite and obvious conclusion.

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