By Dr. OLIVER GOLDSMITH

Many people believe doctors shouldn't have to worry about high medical costs that it's the turf of the insurance executive or HMO administrator. But today's practicing physicians have a vital interest in the cost debate.

Basically, we'd like to know that in prescribing a procedure, we aren't asking our patient to choose between paying the rent or getting the treatment.

We are fortunate to live in an era when the science of medicine regularly produces miracles. Advances in treatments, pharmaceuticals and technology in the last 30 years eclipse the collective achievements of the prior 300 years and have clearly extended and improved our quality of life. But the price tags that come with these advances have pushed health care coverage out of the reach of many individuals and employers.

As we've heard, the newest fertility treatments work very well. Science can help an infertile woman conceive and deliver a child, and sometimes twins, triplets, and recently, quadruplets. The treatment is expensive and the pre- and post-natal costs of caring for multiple babies can reach the millions. At the same time, we have hundreds of thousands of children already among us whose parents' lack of coverage means they haven't had basic immunizations.

In short, medical advances offer us unprecedented opportunities to counteract debilities and improve our quality of life, but create dilemmas about how to allocate them. Because we don't have societal consensus or a system in place to make allocation decisions, that role has been falling more and more to the health plans and insurers.

Every day someone somewhere is making difficult decisions about the application of limited resources in order to find a balance between access to cutting-edge technology for the fortunate, and access to basic health care services for the general public. Employers (and their employees) should be paying attention to who is making these choices in their health plans.

There are two key arenas for discussions of resource allocation: the hypothetical, global arena in which scientific effectiveness is examined and treatment guidelines are created, and the up-close-and-personal arena the exam room where a physician and patent are deciding on an individual course of treatment.

As a doctor who has practiced medicine for 25 years, I can tell you that the first question all employers and patients should ask when choosing a health plan is, "Are the doctors able to make treatment decisions with the patient and no one else involved?" To do this, doctors need to have available the most current research and treatment information (and it doesn't matter whether the source is a scientific institution or the insurer as long as it's good information). Then, they must be allowed to practice medicine, which means that the business side of the health care equation should not intrude into the patient-physician decision-making.

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