Cost of Health Care and the Role of Physicians

To the Editor: Dr Webster suggests physicians are to blame for the uncontrollable cost of health care through their ordering of expensive but unnecessary tests and procedures.¹ In my opinion, the increase in health care expenditures is not caused by irresponsible physicians; rather it is due to improved technology, new medicines, and longer life spans. For example, the risk of death from cardiovascular disease has decreased by more than half in the past 50 years.² This was achieved by using modern and expensive techniques. Just 30 years ago, a patient with a myocardial infarction was offered an aspirin and a β-blocker at the cost of less than $10. Compare this with the modern standard of care, in which emergency angioplasty costs at least $10 000. Additionally, patients treated with aspirin and β-blockers did not survive as long as patients treated with angioplasty do and therefore would not incur further health care costs, whereas a patient who benefited from angioplasty could live another 20 years or longer but would need ongoing and potentially expensive medical care.^3- 4 Likewise, increasingly sophisticated and expensive cancer therapies allow patients to survive but also to continue to consume health care services.⁵