Letter: How to really reform health care

The tragedy of this series ["Balancing Act: Bleeding us dry," Editorial, Nov. 14] is that it builds on old prejudices and flawed analyses that are setting a trap for Americans rather than promising us a better future.

Yes, as you put it, we are often paying exorbitant prices for health care. We are at the same time putting our lives and those of our loved ones on the line by giving them the kind of lowest-common-denominator care, which has become the standard in many of the countries we misleadingly cite as fortunate because of their low total health expenditures. Cutting $1 trillion, as you suggest, would hardly guarantee a better outcome. Spending the money more wisely, however, may make a much more important difference.

One of our most important errors seems to have been to rely on "managed care," to provide us with the best of all worlds: good care at a reasonable price. Unfortunately, health costs are soaring faster than ever, and health care is deteriorating, thanks to managed care. One of the reasons is clear. We have exchanged a nonprofit insurance system for a for-profit one. The health insurance companies have as their primary goal making as much money as possible for their shareholders.

Then you give us an unfortunate misleading tale: "Hospice care, for example, can actually prolong life even while saving money." Have you visited any hospices lately? The only way to lower costs for the care of very sick patients is to shorten their remaining lives.

As I was caring for a hospitalized patient recently, a nurse complained to me about the new spirit that is getting the upper hand in medical care. He told me that there was a patient whose intravenous fluids were discontinued and who at the same time was receiving continuous infusions of morphine which were being increased every day -- a very common scenario.

Finally, while we need new drugs, in the last few years the cost of new drugs has escalated to astronomical heights that cannot be justified simply as a way to encourage new drug development. Some drugs now cost more than $400,000 a year per patient. It is we who are permitting that to happen.

Dr. Yashar Hirshaut, Manhattan

Editor's note: The writer is an oncologist and chairman of the Israel Cancer Research Fund.