In this election year, plans for health care are front and center. I urge that we all examine the presidential candidates' health proposals closely and take each plan into consideration when deciding for whom to vote.

Sen. John McCain and Sen. Barack Obama agree that our health-care system is in crisis, yet each candidate offers a different solution. Unfortunately, the discussion of the candidates' proposed health policies always covers insurance and coverage rather than the more difficult questions of ensuring quality care, reforming physician reimbursement and promoting health and preventing disease.

Providing health insurance for all Americans, whether through a public or private solution, is only the tip of the health-care iceberg. A larger insured population combined with the aging baby boomers will result in a dramatic increase in demand for health care. This, combined with inflation, will certainly lead to an unaffordable increase in costs.

The common solution is to cut costs by reducing payment for care. In the last few years reimbursement has been cut to the bone, and further decreases will do no more than reduce quality of care — the number of nurses per patient in most hospitals, for example, is not ideal, and cutting pay to doctors means they will have to do more in order to make ends meet, leading to further rises in health-care costs.

We must focus on health rather than disease. Physicians should do everything they can to prevent and screen for illness. To date, primary and preventive care are so poorly reimbursed that physicians who work as internists, family physicians and geriatricians are a vanishing breed. In order to survive, they also try to increase revenue by ordering more costly tests and procedures, many of which are often unnecessary. We must restructure the incentive system and reward physicians for quality of care rather than quantity.

In addition, we must practice care based on sound scientific evidence of benefit. Today, physicians perform millions of unnecessary tests and procedures that are of no proven benefit. Millions of dollars are spent on the most expensive prescriptions rather than the best medication. The consequence of unnecessary tests and inappropriate medications is increased admissions to hospitals and more money spent on fixing a problem that did not exist.

Physicians have a major responsibility in policing themselves to avoid inappropriate and excessive care. We perform too many stress tests, CT scans and open-heart surgeries where the evidence of benefit is minimal. And it is not just the cardiologists who are guilty of performing unnecessary care; geriatricians are performing tests in nursing homes that are rarely indicated. If physicians become more discerning about the care they deliver, costs could decrease by billions of dollars annually.

Senator McCain rightly demands that we all become more involved in how our health-care dollars are spent. But will we spend those dollars on screening or prevention, if we do not see an immediate benefit? And if an illness is serious, "Please spare no expense; I want the best" is a common refrain. Controlling how our dollars are spent requires that we be educated about an illness that afflicts us and know what questions to ask our physicians. How will the treatment help? What are the side effects? Are there studies demonstrating benefit? Remember, just because a procedure is recommended does not mean it is the best for you.

Senator Obama proposes establishing an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have the accurate and objective information they need to make the best decisions for their health and well being. However, there is no real plan to substantially reduce care that is of no proven benefit or is clearly unnecessary. Just think of the national outcry that occurs if an insurance company denies care to a seriously ill patient, even if it will clearly do more harm than good.

The solutions to our health care crisis are multifaceted and will only succeed if we all become involved, empowered and committed to creating a system that meets the needs of everyone. Medicine must once again become the noble, rather than the bottom-line, profession.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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