Today is the formal launch of my new health and medicine blog. Be sure and read the Mission Statement to see what it is all about.

To get things rolling, I will give you a couple of links to newspaper articles. The articles are the typical kind of published “debate” that you see these days. This is one is interesting because it is the bean-counter’s argument that actually makes the case for physician and quality choice in one small area of health care. Today, a small step . . . Tomorrow, who knows?

Are cost controls for medicine bad? No

Are cost controls for medicine bad? Yes

Dr. Jeff Kamil is the chief medical officer of Blue Cross of California. He tries so desperately to make the case for providing as many less expensive, non-hospital based colonoscopies as possible that he inadvertently proves the point that Dr. Emmett Keefe, chief of hepatology at Stanford University, attempts to make. Namely, that it should be your doctor’s decision as to whether or not you need to have the procedure done in a hospital outpatient setting.

Dr. Kamil cites the telling statistic in this “battle” of quality versus quantity. He indicates that at the current time, having a colonoscopy performed in an outpatient surgery center is just as safe as having it performed in a hospital outpatient setting. I, for one, wouldn’t want to argue with him.

Why do you suppose that the risk is the same in both settings? Could it be that by allowing the physician to make the call as to what setting is most appropriate for each patient minimizes the risk while containing costs? And as Dr. Kamil also points out, right now about 2/3 of all colonoscopies are performed in outpatient surgical centers and physicians’ offices. It seems to me that our physicians’ clinical judgments are safe and effective.

Yet, Dr. Kamil proposes to abolish a system that is working and in its place proposes another in which the cost of the colonoscopy would become the primary determinant of the setting. Dr. Keefe would propose that we continue to let physicians make this determination. Do I want my doctor to have the final say or do I want the cost to Blue Cross as the most important factor?

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