Editor’s note: Judy Bachrach writes for Vanity Fair, and is the creator of thecheckoutline.org, an online advice column for friends and relatives of the terminally ill.

Before the health-care debate goes any further — and it will go a lot further, no matter what kind of bill gets passed in Congress — let’s stop and examine who’s really responsible for making sure health-care costs are lean, sensible and bear some sort of resemblance to the quality of the actual medical services performed.

You are.

That’s right. The first thing every patient forgets when she checks in at her doctor’s office and observes the person behind the desk, completely mute, immobile and sunk into what appears to be a deep coma – is that she’s the one in charge. And by that I mean you the patient are in charge of everything: the doctor’s prices, the doctor’s courtesy, the doctor’s assistants, the doctor’s promptness (or lack thereof) and above all, the quality of the doctor’s services.

There are rules I invariably follow whenever I check in with anyone whose last name ends in MD, and they all have to do with how much I will pay for any visit to any doctor, no matter how exalted, revered or specialized. I know it sounds strange, especially in this day and age when far too many women are in awe of practitioners, but I’m the one who sets the doctor’s fees. I’m the one who makes sure those fees are more or less what my insurance will cover. I’m the one who insists that specific services, promptness and courtesy be offered in exchange for those fees.

And not only for me, but for any relative or friend, especially if that relative is elderly and cannot fight for herself.

To read more, click here to go to obit-mag.com.