Froma Harrop's column in the Spokesman ("Preventive care doesn't save money," July 18) is an intelligent commentary on an aspect of medicine too often ignored. Preventive care is good, but keeping a septuagenarian alive till age 90, or even 80, is expensive.

As an elderly recipient of heart surgery, I know hospitals cost a lot. Though glad for extra years of life, I realize senior citizens have a personal responsibility to keep costs down. I visit doctors sparingly, take generic medicines and learn to live with arthritis and macular degeneration. Disciplined exercise at home and sensible eating habits cost less than physiotherapy and diet foods. I update my living will about what not to do in prolonging unacceptable disability. -- Keith Dahlberg, M.D., Kellogg (Full letter here.)

While Harrop and Dahlberg are correct in their facts -- living longer does end up costing more -- I wonder if that fact can be talked about merely as a fact that must be dealt with in addressing health care costs. To me, it seems like the conversation would naturally and quickly devolve into pressuring people to die sooner, especially when their age brings on expensive disabilities.

Sometimes, as Dahlberg points out, personal wellness measures can reduce costs and living wills can prevent expensive "extraordinary measures," but individuals can still become highly functioning but costly patients through no fault of their own. Can health care reform be talked about without "going there"?

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