Health Cost: What Limit?

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program. Dr. William G. Anlyan, vice president for health affairs at Duke University Medical Center in Durham, N.C., gives this example: "Today, the patient with a heart problem sees his family practitioner who refers him to a nearby cardiologist, who then refers the patient to a tertiary center like Duke. He's evaluated by a clinical cardiologist, then goes to a group of diagnostic laboratory cardiologists and radiologists. If the patient is to be operated on, the surgeons, the anesthesiologist, the pump team, the blood bank in the institution that feeds the pump are involved. The patient goes to a special recovery room with specially trained people to watch him. He's there five days with round-the-clock care. He goes to a rehabilitation unit for the rest of his recovery."

While such elaborate procedures might be justified in the case of a heart operation, doctors generally agree that expensive technology is used much more often than it needs to be, again because no one is watching costs. For instance, hospitals scramble to buy the fanciest equipment available. Secretary of Health, Education and Welfare Joseph Califano charges that hospitals in Southern California contain enough CAT scanners to serve the entire Western U.S.

Major metropolitan hospitals are not the only ones involved in the technology race. Jimmy Carter in April confessed that, as a member of the governing board of Georgia's Americus and Sumter County Hospital in the 1960s he had particpated in bilking his neighbors. Said the President: "We were naturally inclined to buy a new machine whenever it became available. Then we required every patient who came to the hospital to submit their body to the machine, whether they needed it or not, to rapidly defray the purchase. I did not realize then that I was ripping off people." One reason for the emphasis on machinery: the prestige of a hospital is judged by the quality of the doctors on its staff, and the most talented doctors gravitate to the hospitals that boast the most advanced facilities.

Doctors, too, tend to order every test that a patient could conceivably need. In part, that is done to reassure patients or to protect themselves against malpractice suits. Says Dr. E. Kash Rose, senior radiologist at Queen of the Valley Hospital in Napa, Calif.: "One study showed that 80% of skull X rays were unnecessary for care and treatment of patients. Rib X rays are done purely for the mental relief of the patient rather than for medical reasons. The treatment is exactly the same" whether the X ray discloses a fracture or not.

Says Dr. Noel Thompson of Stanford University and the Palo Alto Medical Clinic in California: "The doctor who does something to the patient—sticks something down his throat or up the other end of his anatomy, cuts him open or takes his picture—receives a much larger amount of money." A fierce dispute rages over how much unnecessary surgery is performed on Americans each year. Though the precise figure is impossible to pin down, no one doubts that at least some doctors will operate on patients who could get by without surgery simply because the Government or a private insurer will pay.

If the diagnosis of why medical costs are shooting up is reasonably clear, the course of treatment that could bring those costs under control is anything but clear. It is easy