Some thoughts on Health Care . . .

WhenI graduated med school, there were two decision makers in health care - the patient and the doctor. Today there are one to two major or two minor - the two minor decision makers are the patient and the doctor; the two major are the insurance and drug companies, who decide the medications available and what gets paid.

The key concept is - who makes the decisions? Every patient, every situation is different. No, I don't start a 90 year old man on a lipitor because of recently elevated cholesterol if his health is otherwise ok. No I don't start an obese diabetic on insulin without careful education about diet. Yes, I do advise a 35 year old person to have a routine ekg if he or she has never had one before; it's a valuable baseline and may pick up undetected problems.

The point is - these are all independent judgment calls for the benefit of the patient. This system of doctor- patient relationships worked well and cost effectively for many years. Given the increasing burdens of medicare denials and rules and the confusion of reading your health care policy, will a 1,000 page confusing and conflicted set of rules really improve health care? The present system has real problems. Let's not make it worse.