At least from one perspective, no matter who wins this November and no matter how he sees the future of American health care structured (private insurance based, universal coverage or a hybrid model), one key issue will be the same - utilization. By utilization, I mean how often the health care consumer uses health services and what level of technology does the s/he use.

Most often early detection services that have PROVEN themselves (like colonoscopy at age 50 to pick up colon cancer early on) will be encouraged. Preventive technology like immunizations are cost effective - preventing shingles in seniors or a certain meningitis in adolescents - and will be supported.

However, utilization of useless technology (high cost - dubious outcome) which is supported by many health care providers like overuse of CT scans, MRIs, PET scans and lab tests (often at the behest of patients and/or their lawyers) that can not result in better outcomes for patients will be severely limited in the next decade - starting with whomever becomes president. Use of expensive brand name drugs when there are reasonable alternatives for less cost or with less adverse reactions will be dramatically discouraged. In short, if you are upset with managed care for “limiting your doctor”, you ain’t seen nothing yet my friends.

The reason, with all that we spend on health care in the U.S. we have the WORST medical care in the industrialized world - only ignorant radio talk show hosts and politicians lobbied to death by pharmaceutical and diagnostic testing companies say otherwise.

This does not speak well for a “give them whatever they want” approach. This is coupled with the fact that the economy is in real trouble while the cost of health care is STILL rising and the number of boomers that are reaching the age of requiring more care is dramatically increasing.

In short, there is NO WAY that we will return to the time of the “Horn of Plenty” in health care. And while you lament, may I say that it could be a blessing in disguise. We may have to eat right, exercise, learn to relax and take responsibility for our physical, mental and spiritual well being. We may have to learn to UTILIZE our health care resources judiciously. What a novel concept.

I am probably going to do this in parts. It’s a lot to swallow and its implications are at once global, immediate and quite frightening. On Sunday, July 6, The New York Times published an incredible article about an anti-cancer drug called Avastin. Produced by Genentech and marketed with its partner Pfizer, this drug costs somewhere, depending on the kind of cancer it is employed for, the weight and physical condition of the patient and what the hospital or medical doctor who prescribes the drug chooses to charge for the drug, between $5,000 to $9,000 per month or between $50,000 and $100,000 per year when all is said and done. This does not include associated indirect expenses.

Most likely, you would say that this cost is tolerable (albeit expensive) if it saves lives. Ah, but there is the issue. At best it improves the quality of life of the cancer victim and extends their life by 3-4 months! Furthermore, it has side effects, that, in some cases, could kill them.

Insurance companies pay a chunk (depending on the cancer patient’s coverage) and many must find (scrounge, borrow, beg) for the co-pays that could be thousands every month. Even if the Feds or your private insurer pays for part or all of the costs, in the end YOU pay the bill because these costs are spread over everyone’s future health bill and so you ultimately pay a piece the next time your insurance goes up or Federal insurance like Medicare limits benefits or comes closer to bankruptcy.

According to The New York Times, 100,000 now take Avastin (first used for advanced breast cancer by the way). Hundreds of thousands could be added if the drug is successful. (And what does successful mean - 2, 3, 4 months?)

To be sure there is ongoing research with this drug and perhaps it will prove to be decidedly effective in certain cancers or that it must be taken for years and years if it works - perhaps it will not. How will we then pay the bill? And, Avastin is just one such drug. There are others. In 2007 we spent, in the U.S., $286.5 billion for pharmaceuticals! If it gives 3 or 4 months of life - is it worth the cost? If it makes a cancer patient feel better while they are alive - would you pay the cost?

We have come to a crossroads that our politicians do not want to discuss with you. Most are well-off enough and their insurance coverage generous enough so that this will not become a crisis should it happen to them. But, who is going to decide who lives and who dies? Who will decide who is treated and who is not? Which drugs will be acceptable and which will not? (Certainly Avastin’s efficacy is NOT clear yet and still it remains approved by the Feds and reimbursed by private insurers.)

If McCain wins in the fall, private insurers will have a lot to say about who shall live and who shall die because he is in the pocket of private industry just as Bush has been. If Obama wins, then it could be Congress and Obama’s health team that make these decisions in a national health politic. In both cases, the people have no input!

Cultures differ in this country from state to state and region to region. To my mind, there is no uniform answer for America. Let’s do what our founders did - give us the truth - the real problem, our economic and logistic limitations and let us - the people decide.

McCain’s “free market” idea is health care voodoo economics - an elitist pipe dream. Obama’s concept from the left does not address this issue and shows no vehicle for us to decide our own fate - no matter how painful that will be.

One last thing, do the President and Congress decide that Iraq expenditures are more important than your loved ones’ lives? Up until now you have been blinded to the “Guns and Butter” issues that will directly affect our lives. Health technology, even if only partially successful is not going to be, but is, blindingly expensive. You can’t have both wars in Iraq, corporate mismanagement, federal waste AND expensive health care for every one. Something has to give. Who decides? It time for the “PLAIN TRUTH” AGAIN!