Uwe Reinhardt is a fine economist who probably knows more about health policy than any other economist - except of course for Wonks Anonymous - and he has been writing extensively in Economix in the Times on health care costs is the United States.

Wonks Anonymous would like to say that this highly trained and experienced economist is spot on, in his analysis. Alas he cannot. Mr. Reinhardt has done a number of good pieces laying out the differences in the cost of treatments for various diseases - classified by Diagnosis Related Groups - between hospitals and doctors. Like many other economists he has called attention to the cost of various high technology treatments, questioning the efficacy of some and asking about the wisdom of allowing others for people who are unlikely to be around much longer to benefit from them.

Professor Reinhardt has done an excellent job of describing a particular class of trees while entirely missing the delicate and complex ecology of the forest.

Good medicine should not be about treatments, hospitalizations and operations. Good medicine should be about a cooperative effort between patients and health care providers to produce the best possible health. When we focus our policy discussions on payment for high tech medicine and rationing of high tech treatments we risk arrogating to ourselves decisions which we are ill qualified to make as economists and policy wonks. We also tend to miss the point.

Here is an example from the back files of Wonks Anonymous:

Medicare currently spends about one quarter of its budget on End Stage Renal Disease, kidney failure. The treatments for kidney failure, dialysis and transplants, are expensive.

At this point we could enter into a long discussion of various topics: Which hospitals had the best dialysis programs. Who had the cheapest kidney transplants. Should people over 80 get transplants? We could even discuss a possible market for kidneys.

But we would be missing the point. Which is this: Kidney failure is most often a preventable illness, caused by untreated high blood pressure. High blood pressure destroys the delicate plumbing of your kidneys. High blood pressure is easily treated with medications that are, to be crude, butt cheap.

If poor people had easy access to primary care physicians and if they were encouraged to use this access they would be much more likely to get treatment for high blood pressure, diabetes and a host of other chronic conditions that currently go untreated. It is these conditions, left untreated, that drive a great part of our demand for high tech medicine.

After we try easy access to primary care and see how much it saves us in the long run, Wonks Anonymous will be more than happy to debate all that other stuff.