The Demand Side of Health Care
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Steven Pearlstein's June 17 column, "Self-Help for the Health-Care System," was informative but missed a major point. He relieved health-care consumers of any role in the exorbitant cost of medical treatment. One would think that the doctors he wrote about work in a vacuum, dispensing unnecessary tests and ineffective treatments to an apathetic public.
As a practicing surgeon, I can assure Pearlstein that much of the over-utilization occurs at the behest of patients. Insurance has largely removed any incentive for patients to be efficient with medical resources. Many patients feel that their insurance card is a medical credit card -- with the bills being sent to someone else.
The role of patients needs to be defined by the following questions:
Are patients willing to accept a generic or alternative medication against their wishes? Would they be willing to accept "no" as an answer when inquiring about an expensive procedure or test? Would they want physicians to be able to limit the end-of-life care available to a terminally ill family member? Would they want unlimited access to specialists curtailed?
Historically, Americans have answered "no" to all of the above questions.
Perhaps in Pearlstein's next column he can address the "demand" side of the equation. After all, the doctors are not providing the "supply" into a vacuum.
-- Alan Kravitz
Rockville
