The comments by Gail Koelker, MSN, RN-C, FNP (Item 115-3), reflect the need to avoid unnecessary expense in the workup of her patient with erectile dysfunction. In reply, David T. Noyes, MD, also suggests less expensive alternatives. Both these sentiments suggest a cause, as well as a remedy, for the spiraling costs of health care. Third-party payment has made it too easy for us to provide costlier care without great attention to the burden on the health-care system. Obviously, every penny spent by the insurer for this care comes from other consumers. Also clear is the ideal of providing competent, cost-sensitive care, whether patients pay wholly themselves or with funds provided by other premium payers. And yet we balk at efforts by insurers to manage these expenditures. In my view, this need for cost containment won’t go away when the taxpayer is made the payer and may become even more stringent under such a system.
—John A. Mosby, MD,Hampton, Ga. (117-25)

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