by Patrick Appel

A reader writes:

The story of $15,000 for a needle in a thigh touches a nerve with me. As a surgeon, I'd have tried to find it using local anesthetic, in my office, before escalating to an operating room. With luck -- and since it was an insulin needle it couldn't have been very deep and would have been near the entry hole -- it'd have been a couple hundred bucks or so, including my fee and the use of a few sterile instruments. It's possible, of course, that it would end up requiring xray guidance; even then, it's hard to figure where the $15,000 went.

But here's the thing: no one would have recognized the savings, or even cared, much less rewarded me for it in any way.

Likewise, when I did breast biopsies in my office, with local anesthesia and comfortable patients, happy at not having to go through the hassles of  surgery at a hospital or surgery center, I saved thousands of dollars each of the many hundreds of times I did it. Again: no recognition, no reward. I just did it because it seems right.

This is part of what gets lost in the screaming rhetoric of the right, the death panels of Palin. Some doctors know how to save the system lots of money, and do so, every day. Establishing a means to discover them and to spread their wisdom is central, as I understand it anyway, to Obama's plan. Not rationing. Discovering why some methods are more successful and less expensive than others. Hard to understand, maybe; and very easy to demagogue. Which is exactly the problem.