Atul Gawande examines why health costs are high some places and lower others

by e-Patient Dave on May 28, 2009

Atul Gawande, MD As soon as you can, stop what you’re doing and devote 20-30 minutes to reading Atul Gawande’s important new article in the June 1 New Yorker, The Cost Conundrum: What a Texas town can teach us about health care.

I don’t claim to be an expert about cost issues but in my year-plus of listening to US healthcare discussions I’ve heard enough to know, from common sense, that it’s a big stinking tangled mess. The results are so dysfunctional that all signs indicate that the root cause must be perverse incentives. But the question is, where?

Every whichway you turn in these discussions people have a ready explanation for why they’re not at the root of the problem. Gawande appears to do a superb job of carefully selecting matched pairs of cities and situations to reveal whether the proposed issue does in fact make any difference. Care quality? No. Overall health of the population? No. And so on.

Gawande is a surgeon and a superb writer who knows his way around an argument. My gut says that from this moment forward nobody can claim to be well versed in health reform issues – and informed choice – if they haven’t absorbed this 7,800 word article.

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13 Responses to “Atul Gawande examines why health costs are high some places and lower others”

ePatientDave says:

May 28, 2009 at 12:50 am

As soon as you can, stop and spend 30 min on Atul Gawande’s new article about HC costs. (My quick post: http://is.gd/HU1W)

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ePatientDave says:

May 28, 2009 at 8:13 am

@TrishaTorrey @jrh3 CNN “divorcing consumers from true cost of their health care” Yes see http://is.gd/HU1W)

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Gilles Frydman says:

May 28, 2009 at 8:17 am

The article is fantastic but long.
So if you have only 1 minute here is what summarizes it:

“Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks.

Here’s how this whole debate goes:

Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance.

Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors.

No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills.

Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve.

These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes.

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ePatientDave says:

May 28, 2009 at 1:13 pm

@TrishaTorrey @jrh3 CNN “divorcing consumers from true cost of their health care” Yes see http://is.gd/HU1W)

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medXcentral (Jim) says:

May 28, 2009 at 5:22 pm

Atul Gawande examines why health costs are high some places and lower others. #healthcare #healthreform (http://ping.fm/wGO0S)

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Un sistema perverso di incentivi alla base della spesa sanitaria USA | Salute 2.0 - Persone, tecnologie e sanità says:

June 1, 2009 at 9:57 am

[...] “The cost conundrum. What a Texas town can teach us about health care”. Segnalata da e-patient Dave, è ben scritta ma piuttosto lunga, quindi [...]

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Jerry Brady says:

June 9, 2009 at 11:54 pm

This article was important for its cut-through clarity the moment it was published. But then Obama read it and waved it at his health honchos so, as the New York Times reported today, McAllen, Texas, has become the center of the health care debate. Every advocate must confront Atul Gawande. That’s quite an accomplishment, even by New Yorker standards. It could be a pivotal piece in the health care debate. I’m persuaded and will write about it Sunday in our newspaper.

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e-Patient Dave says:

June 10, 2009 at 2:40 pm

Hi Jerry –

I’m not clear on what you mean by “every advocate must confront” him. Do you mean anyone who’s advocating any change must confront the reality that Atul described, or are you saying something else?

Great to have you here. Let us know how we can help. epatientdave at e-patients.net.

(Everyone, unless I’m guessing wrong, this is the Jerry Brady who has quite a strong history in Washington and in his family’s media companies.)

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Gary Franklin says:

June 14, 2009 at 1:06 pm

Atul Gawande’s article is right on target. I have been writing haikus on health care reform on Twitter-these are affectionately called twaikus! Please access these twaikus and provide feedback and other ideas-the Twitter username is doctwaiku (http://twitter.com/doctwaiku). Thanks!

Gary

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e-Patients Are Proud Deviants! | e-Patients.net says:

June 15, 2009 at 10:41 am

[...] and expanded on teh theme of his groundbreaking article “The Cost Conendrum” that was reviewed on this [...]

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Essentially Contested America » Blog Archive » The “Public Option” and the Health of Our Nation says:

June 25, 2009 at 5:47 pm

[...] insurance companies? Frankly, these two priorities are increasingly at odds with each other. As Atul Gawande’s celebrated New Yorker piece reminds us, patients are best served, at the lowest cost, in locations where the medical culture is [...]

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Les says:

October 19, 2009 at 5:55 pm

Why can’t the patient be the one accountable for her health care? If there were a reasonably understandable measurement system, and if there were readily available data on these measurements, the patient could select providers that are most cost-efficient. That would be incentive to operate other successful “Mayo clinics.”

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Dave deBronkart says:

June 22, 2010 at 9:14 pm

Just discovered my own May09 post:) – had just discovered US HC is "a big, stinking, tangled mess" http://bit.ly/vIEV

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