Life is full of hard choices. Nowhere is this clearer than in world of medical care.

Now in particular, we are all faced with hard choices.  President Obama has proposed a major overhaul of our health care system.  Just this past Friday, Congress announced plans for a new health care plan.

To pay for the bill, Democrats are proposing a combination of cuts in government health care programs and a tax increase on the wealthy of more than $500 billion over 10 years.

How health care will be delivered for generations to come could be affected.

Are medical costs out of control?  Is the way medical care delivered broken?

I don’t have any definitive answers to these questions but I do have a number of observations/opinions. 

First observation/opinion:  Yes, medical costs are out of control.  Premiums for health insurance are up over 100% over the past 10 years in some parts of the country.

First question:  Why is there so little debate on the thorny issues of medical care, the types of issues that is the major expense in health care delivery. 

Congress plans to reduce spending, how do they propose to do this?   They plan on limiting drug costs, but what are they doing about the difficult decisions?

Let me tell you a real life story, a tragic story that illustrates what every doctor who deals with hospital patients knows are one of the chief causes of why health costs are out of control.  It is a story that rarely gets discussed in the media.  Or if it does it happens with so much fervor, so much side taking that the real issues get lost and the issue is pushed away under the table.

A few months ago, I was involved in the care of a patient who had been admitted to the ICU for a ruptured bowel.  The patient was an elderly woman 83 years old, with a major infection due to this ruptured bowel.   Prior to having this unfortunate event happen this woman was living independently with some assistance.

Not wanting to be in the hospital the woman had delayed by 24 hours coming to the hospital.  Now the infection that had developed was severe.  She had been overcome with what is called septicemia.  It is a condition where the infection has spread throughout the body, through the blood.  By itself a ruptured bowel, with overwhelming infection is life threatening.  But due to the infection; she developed a significant drop in blood pressure.  The patient normally had hypertension and her blood pressure typically ran 150/80 (she was on medications for this).  After her admission to the ER and with the infection coursing through her body, her blood pressure was 70/30.  She was in shock, due to the severe infection.

Three antibiotics had been started, and she was started on powerful medications designed to raise the blood pressure as well as large amounts of fluid needed to keep her alive.  By the third day, her kidneys began to fail.  She became more and more confused.  She didn’t respond to verbal stimulation or by touching her.  By the afternoon of the second day, her breathing had accelerated and her overall respiratory status was beginning to be severely diminished.