We can and should do better. The “we” are the health care providers. Everyone knows health care spending is out of control. Of the sacred triad of health care policy, (cost , access, and quality) the cost is the most important issue to address.

Can we reduce cost, thus increasing access without affecting the quality of care?

The answer is certainly “yes.”

Let me give you examples.

A relative with a history of kidney stones went to a local emergency room at the direction of his physician for acute pain typical for the condition. There was also blood in the urine.

This is no diagnostic dilemma for a physician or even many laymen.

He was writhing in pain and was not there for someone to tell him what the problem was. Indeed, it was the pain that was the problem.

After a 40-minute check-in period and 20-minute delay before a physician directed the nurse to give pain medicine, he was able to get rapid relief.

He was then comfortable and his profuse sweating and pain were gone.

At this point, he was sent for a CAT scan (billed at more than $3,000) showing the stone, and then released.

The hospital bill was more than $7,000, of which the insurance company allowed around $4,000.

Because of the plan’s deductibles, the patient’s share was $1,700. I ask why?

The pain medicine was relatively cheap and readily available.

The CAT scan was not emergent or even necessary as plain films would clearly show this stone. In an outpatient facility, the cost would have been about $450.

When the patient care representative was asked whether she thought the charge was reasonable for treatment of pain, she became defensive. She documented the services and said these charges were usual and customary.

But this was not the question.

A second instance was personal.

After being sent to the emergency room with symptoms of obstruction, my pain and nausea remitted while I was waiting.

The physician and I decided I could safely go home. The charge for the acute abdominal X-ray series was about $850, which was also defended as the customary charge by the billing office.

Again, this service would yield about $100 in an outpatient setting.

Providers have shown that they will not ask the simple question, how can I do a good job at a reasonable price? (I believe this question could also apply to law and finance as well).

If so, there would be alternative ways of care developed, for example, greater use of urgent care treatment, or better use of technology in offices.

Also, tests ordered would be more likely to yield useful results, instead of covering the waterfront (or physician’s posteriors).

Why should a 92-year-old have to go to an office for blood pressure checks in this modern era?

Much of the data gathering could be done at a senior living facility. I believe that antiquated reimbursement practices that require an office visit code are partially to blame.

So who will force a change? A co-op representing the purchasers of health services theoretically would have the incentive.

Insurance companies seem to me to be too much in bed with the hospitals. Free competition among providers possibly could help, as there is much room for profit even providing services cheaper.

Transparent pricing should be demanded.

How many people would purchase a meal without pricing knowledge and say “bill me later”?

My last choice would be government price controls, but this is the most likely. Already we see the genesis of this in the Affordable Care Act. All I know is that we can do better.