The Wall Street Journal. Classroom Edition Debating Current Issues: Health-Care Costs

As health-care costs have skyrocketed in recent years, both patients and caregivers have had to ask a difficult question: Should cost be a deciding factor in medical treatment? In this debate from The Wall Street Journal Classroom Edition, Abbie Leibowitz, an executive at Health Advocate and former chief medical officer at Aetna, and Dr. David Rogers, a physician in private practice, discuss the role of costs in the health-care system.

YES Should doctors consider cost when treating a patient?

By Abbie Leibowitz

It is absolutely reasonable and ethical for physicians to consider the costs of care when evaluating treatment options.

The principle of “first do no harm” that all doctors are taught has broader implications than just its application to the patient. Do no harm in your treatment of the patient for the patient's sake, do no harm in treating your patient from a public-health perspective, and do no harm to the system of health care we all depend upon.

As a percentage of our gross domestic product, the U.S. has the most expensive health-care system in the world. Medical-insurance premiums in the private sector have been increasing far faster than the pace of general inflation. They are projected to double between 2003 and 2012 to $3.1 trillion or 17.7% of the nation's GDP. Such increases are unsustainable and are a prescription for an economic and public-health disaster.

As costs increase, payors—whether the government or employers—shift more financial responsibility to the individual in the form of diminished benefits or increasing co-payments and deductibles. The increasing burden of paying for otherwise uncompensated care is like a hidden tax on those who pay for medical services. Providers simply build these costs into the rates they charge those who pay.

Is it good care to so burden a patient with expenses that could have been avoided? Is it good care to prescribe an expensive brand-name product when there is an equally effective generic equivalent that costs less than half as much? If because they cannot afford the cost of care or medicine, patients do not get their prescriptions filled, have we helped them? We have no choice but to exert a conscious control over medical costs.

Resources are not limitless. When given the choice of equally effective diagnostic tests, treatment approaches, or medication options, physicians must consider which is likely to cost less. Our patients' needs are our first priority, but the health-care system we all depend upon is also our “patient.”

Doctors must consider both the costs and benefits of treatments when choosing the best treatment for a sick patient.

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