To the editor:

Your editorial of April 22, "U.S. must rein in medical costs," is certainly true. It is also clear that malpractice costs must be reduced.It is unfortunate that there is a great deal of lab work that must be done as a legal protective measure but which may not be necessary from a medical point of view. Also, the cost of laboratory services is going up even more due to a misconceived plan by the federal government to regulate laboratories.

Above all, we need to be aware that until we learn to practice prevention, the cost will continue to go up due to new procedures and new equipment. George Bernard Shaw said it best almost 100 years ago when he wrote as part of a play, "Why is it we will pay a doctor to take a leg off, but won't pay him to keep it on?" It is unfortunate that many insurance companies won't pay for preventive exams.

It is quite clear that a lot of things could be done to prevent accidents and reduce severity of accidents, such as using seat belts and shoulder harnesses. Until something is done to require alcohol and tobacco to pay their way, since cigarette smoking is the greatest single cause of preventable illness and alcohol is close behind, all of us will be paying for preventable health-care costs.

It is extremely unfortunate that AIDS, a completely preventable disease, will continue to increase health-care cost as long as drug abusers share needles and fail to learn from other high-risk groups about using existing knowledge of prevention.

Regardless of what we do about insurance and setting limits on what can be paid, until we begin practicing adequate prevention, the costs will continue to increase. Until we have to pay for lack of prevention, most of us will tend to ignore it.

Harry L. Gibbons

Director

Salt Lake City-County Health Department