As a family doc I agree something needs to be done about health care costs. In medicine, the right diagnosis is necessary to determine the right treatment. Let me share a mnemonic I once learned. A mnemonic is a memory technique of using a word in which each letter stands for an idea. The mnemonic for the healthcare cost problem — SOGGIL — in which each word is preceded by the word "Too."

Too Smart: Since I graduated from med school in 1983, it's just amazing the advances that have been made: like cardiac stents, organ transplants and MRI's, but unfortunately medical technology is expensive as prices go up; but never come down.

Too Old: Life expectancy keeps increasing and aging means an increased need for expensive medical care. For many, it's amazing how much can be spent on squeezing out the final few days of life.

Too Generous: Generous employer and governmental programs that offer top shelf healthcare benefits paid for through our taxes and insurance premiums have elevated patient expectations to an unsustainable level. When somebody else pays the bill, why just have a Chevy when you can get the Cadillac? Patients are also bombarded with ads that promise scooters, supplies, braces, and medications accompanied by the “Paid for by Medicare. No cost to you!” claims.

Too Greedy: Today's patient runs a gauntlet of money-grabbers who do a "wallet biopsy" by putting their hand on your billfold and then say "turn your head and cough." Seriously, the healthcare prices are nothing to laugh about as they have stolen the financial hope of many a young couple and are a common cause of bankruptcy. There is a seemingly total lack of conscience in the pricing of medications and procedures.

Too Insulated: Medicine is a unique business relationship in which the buyer (patient) and the seller (doctor/hospital/pharmacy) are insulated from the cost by a "third party" (insurance). This insulation results in a lack of restraint in controlling the costs found in normal buyer/seller relationships. Increased “third party” involvement beginning in the mid 1960s is at the root of escalating costs.

Too Litigious: Any adverse outcome can result in lottery-like settlements without the need to prove malpractice. Because of this, numerous expensive tests are ordered defensively.

The above refers to diagnosing why healthcare costs are so high, but how do we treat this problem? Here are suggestions using our mnemonic SOGGIL.

Too Smart: Britain's National Health Service has utilization review panels to determine which surgical procedures, imaging studies, medical equipment, and medications are allowable based on effectiveness. Unfortunately, this may not jibe with Americans' independent, selfish attitudes.

Too Old: A very large percentage of U.S. healthcare dollars are spent at the end of life in hopes of a "cure." The British are better at switching to palliative care (comfort-type care) than traditional American medicine, which is focused on curative care. Realistic establishment of resuscitation status would prevent much suffering and save billions of dollars.

Too Generous: Plans must be less generous than our current unsustainable expensive model. "Medicare for All" runs the risk of knocking the U.S. treasury doors off the hinges in terms of spending money. Governmental programs are great at increasing taxes, but not good at controlling spending. Proactive austerity measures could involve perhaps setting a goal of “beer” level basic universal health care with an option of private pay enhancement to “champagne” levels.

Too Greedy: A system could control the greedy entrepreneurial spirit in capitalism without squelching the legitimate research by establishing an oversight committee to: 1) set global fees based on diagnosis, 2) evaluate efficacy of medications/devices, and 3) study cost effectiveness.

Too Insulated: Healthcare reform needs to emphasize not just coverage, but also cost control. By requiring prices to be easily known, patients and doctors will ask the ultimate question: How much is this going to cost? Much of the over-utilization stems from insured patients' demands and medical providers' indifference over costs since someone else is paying the bill. Maybe this would stimulate true competition in healthcare?

Too Litigious: Possibly set reasonable financial limits for settling cases of negligence to rid the system of unreasonable “lottery-type" settlements?

If you like it, feel free to share this letter. If you don't, please put it in recycling. I've got to get back to doing paperwork and prostate checks, but it would be more than a shame if we just left this mess we've created to our children.

Dr. Dan Retzer is a Rockford resident.