PROVIDENCE – Well, here goes, the last time you will hear anything from me on this subject.

I hear frequently from people I care about, and sometimes even from those who I do not, about their anger and confusion over the financial assault they are feeling from our “health care delivery system.”

I am losing sympathy for all of them. I am sorry to say that my lack of sympathy comes from their unwillingness to think about the root causes of our problems with providing access to quality and affordable medical services to all of us.

One last try. Here is why our costs keep rising despite what our leaders would have you believe about their solutions to this “wicked” problem. There are three forces driving the increasing cost of services:

• Our aging population with increasing rates of chronic diseases;

• Increasing investment in biomedical interventions that cost a bundle and often yield little to increase our quality of life and longevity by trivial amounts; and

• Avarice and hubris. Prices are increased for the same drug or service just to put more money into hands at the top of large institutions in control of access and finance.

Equally bad news
As Walter Mondale once told the American people about his plan to raise taxes, I have equally bad news. Costs will always rise under the forces described above. Yes, we can try to figure out ways to expand access to insure those who remain uninsured and perhaps even make their co-payments and deductibles more affordable, but the only way we will see real changes in the economics of health care is with rationalization of our delivery system’s capacity and rationing of high-cost services.

We knew all this 50 years ago. There actually was legislation created by Congress to address the rising cost of medical care. It was called the “Regional Medical Program,” or RMP, a program of community health planning that included all the medical resources available in a region that might be mobilized to meet a specific medical objective.

The RMP was authorized under the Health, Disease, Cancer and Stroke amendments enacted by Congress in 1965. It died prematurely at the hands of the Nixon administration; Reagan followed up with the elimination of all federal assistance to create comprehensive health planning in the U.S.

Regional planning under the RMP was the target of a powerfully financed communications effort to convince us that government was the problem and not the solution to this or any systemic problem in our country. We are now seeing the same effort to destroy other systems, but I digress.

Health for all?
So, if we want health for all, we need a plan, probably one for each of multiple levels of service: community-based services to acute hospital care. It won’t happen, however, in my lifetime. I know this. I am not happy about it, but I have decided to not let it make me crazy.

I want to apologize to all who have seen my anger and frustration in social situations when I allow myself to be sucked into participating in such discussions.

Next time someone tries to get me to discuss the high cost of care, I am planning on changing the subject; perhaps to the future of our Red Sox, or whether Robert Kraft should be allowed to continue to own the Patriots. I am making a list.

Dr. Peter Simon, a retired pediatrician, is a frequent contributor to ConvergenceRI.