HOUGHTON – In a Thursday presentation on the rising cost of health care, a public health expert raised the paradox of the “physician’s conundrum.”

The “physician’s conundrum,” Dean Sienko said, was put forth by medical ethicist Daniel Callahan, who said Medicare should restrict benefits based on costs and other considerations: while physicians won’t be comfortable denying what they think is essential care, if they don’t become active, patients will be forced to ration care themselves due to escalating co-pays and deductibles.

As a way of minimizing waste in health care – estimated at $500 to $750 million – the American Academy of Family Physicians has suggested reducing low-value procedures, such as pelvic exams to prescribe oral contraceptives or screening women over 65 for cervical cancer if they have had adequate prior screenings and are not otherwise at high risk.

The highest spending is concentrated in the top users, with the top 10 percent making up more than 60 percent of spending. The “moonshot” to cure cancer will have a cost of several hundred billion dollars, so targeted cancer therapies could cost up to $30,000 per month, giving most patients a few extra weeks of life, Sienko said.

“If we are a just and caring society, is that something that we should invest in? Because if we do, then we’re going to have to shift those costs,” he said.

Sienko is associate dean for Prevention and Public Health, director of the Division of Public Health and acting director of the Institute for Health Policy at Michigan State University College of Human Medicine.