For instance, every year about 80,00 Americans get a carotid endarterectomy, a kind of Roto-Rooter job on the clogged neck arteries. Typically costing $9,000, counting the bill for the hospital stay, the operation is designed to prevent strokes. Another triumph of modern medicine? Or an overly risky, overdone alternative to cheaper drug therapy? Incredibly, no one knows for sure, and no one is tracking the patients on a systematic basis to find out (Marmor).
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Eliminating waste from the health care system is imperative. However it is not good to make "expensive" synonymous with "medically unnecessary." In this struggle to contain cost, four areas of waste have been identified: ineffective or harmful, of uncertain effectiveness, ethically troubling, and ineffective (Marmor). No one disagrees that harmful care should be done away with, and almost everyone would like to see more cost effective care. It is when the argument reaches the categories of "uncertain effectiveness" and "ethically troubling" that things get interesting. Most physicians are likely to resent anintrusion upon their clinical judgment, patients would be unlikely to accept denial of a procedure they think to be beneficial, and the world can never seem to agree on what is morally correct. "While many physicians will refrain from performing procedures known to be ineffective, most will not be willing to unilaterally cut [sic] other 'wasteful' activities" (Marmor).
HMOs are overly concerned with profit margins. The physicians employed by them work under a system of capitation through which a physician receives a certain amount of money per patient no matter the frequency of office visits. Dr. Ronet Lev, an emergency physician at UC San Francisco Hospital, states: "When I was in medical school, which wasn't that long ago, you would do the best for the patients. Now, with the capitated system, the pendulum has swung the other way and instead, you do the least" (Uche).