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Attacking Healthcare Costs Where it Counts

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Kudos for Barbara Sadick, a features writer for The Wall Street Journal, who today pointed a finger at the real culprit in the crisis of rising healthcare costs. It's not the vague bogeyman problem with the health-insurance business that liberal politicians have been waving at us for decades. It's not medicare fraud. It's not drug companies gouging helpless users of prescription medications. It's not any of those straw-man issues that decoy us from facing the real issue.

The problem is poor decision making. Especially, poor decision making on the part of patients, who want to be pampered with the "best" treatment possible, regardless of its cost or appropriateness.

I remember an old quote: "I have met the enemy, and they is us!"

Thirty-five years ago, when I was engaged in making my paltry contribution to development of magnetic resonance imaging (MRI), we talked about how medical diagnostic tests never go away. Whenever a new and better (spelled m-o-r-e-e-x-p-e-n-s-i-v-e) procedure gets developed, doctors fearing censure for not doing their utmost for their patients rush to use it. They don't, however, drop the old test. What if the old test finds something that the new test misses? What if the new test finds something the old test misses? Will I be liable for the error?

We can't just blame doctors, either. In a crisis, patients, not having the least idea what's happening to them, make ill-informed emotional decisions in a panic. Or, people looking for attention run to the doctor when there's really nothing wrong.

We have a host of problems driving healthcare costs up, but all of them boil down to a culture of poor decision making when it comes to medical care.

Ms. Sadick's articles do not provide the final answers. They, however, at least ask the right questions. The issue is not who pays for medical care. The issue is how to improve the way we make the hundreds of thousands of individual decisions that affect medical costs. We have the best understanding of medical science ever. We have access to the most powerful medical technology ever concieved. We're just stupid about how we use them.

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