Tuesday, June 9, 2009

The New Yorker has an excellent article by Atul Gawande, about why health care in the US is so expensive. So excellent, in fact, that President Obama made it required reading for his staff.

I don't know what specifically Obama liked about it, but I think it does a great job of explaining what "regional difference in cost of health care" looks like, and (possibly) why it happens in the first place. I worry, however, that the subtle nuances Gawande gets to explore at length in a few thousand words for the New Yorker will get totally ignored when the discussion shifts to newspaper articles and op-eds, YouTube videos and TV commercials. You can see this beginning in the NYT piece:
"There is too much uncertainty about the Dartmouth study to use it as a basis for public policy," said Senator John Kerry, Democrat of Massachusetts. "Researchers can’t explain why some areas of the country spend more on health care than others. There are many reasons spending could vary: higher costs of living, sicker people or more teaching hospitals."

Sure, but this conveniently sidesteps the real issue: overprescription of medicines and procedures, which is both expensive and, quite probably, harmful to patient health. Fix the overprescription problem and you save a substantial amount of money, everywhere across the country, while improving patient health outcomes. It's too intriguing an avenue of exploration to not use as a basis for public policy.

It seems a little unlikely that what Gawande calls for - a series of government-incented local experiments into how best to remove the profit motive from doctor decision-making - will be forthcoming. Nothing like it really appears in the latest draft bill from the Senate, although it's too early for this one article to have had that kind of dramatic impact on the legislative process. And it's not like the Senate is where we should look for innovation. As this really interesting process piece from the NYT notes, the Senate (to steal from the NBA) is where craven happens:
Some House Democrats I talked to have already begun to wonder audibly why they’re the ones who always have to surrender in Emanuel’s middle-of-the-night negotiating sessions. They accuse Reid and his lieutenants of repeatedly placating Republicans to avoid a filibuster, rather than taking a stand on principle now and then. Why not force centrist Democrats to vote against their party and let Republicans filibuster the agenda on national television?

1 comment:

pupi said...

This is absolute fact, and its pretty simple. Health care is so expensive here because there is no competition. Every health care company is "for profit." Meaning that when you pay your health insurance bill, the majority of your money goes to pay the health insurance companies instead of directly to the doctors and nurses and hospitals. When things are privatized that means that they can charge you whatever they want to and the government can't make them stop, and the people can't fight for them to stop because it is legal for them to do whatever they want to. hechizos