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Health-care investment

Plested rejected the idea, that medical care consumes too much of the nation's wealth. he asked, "What's more important than your health?"

Efforts to peg physician pay to develop performance, which has become part of Medicare's arsenal to manage costs, are misguided, Plested said.

He said, "The problem is who sets the standards?"

What are they based on? Do they take into account the totality of the practice? Specialty societies struggle with defining what good care is. It is impractical to think that Medicare or an insurance company can describe quality more successfully than the profession itself, Plested said.

He asked, "Do you want to affect behavior by setting rules or have the profession guided by a sense of ethics?"

In the fullness of time, the solution to medical cost increases is better technology, more sensible expectations on the part of patients and more use of nonphysical medical providers, Plested said, but several decisions about medical care and costs go to the public, not to the physician.

"There is no way everyone can have all of the care they want to have," Plested said. There simply are not sufficient resources to go around. "If you have the means, do you have the right to pay for the things you want?"

Physicians cannot make those decisions and government must not, he said.



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