The Problem With Health Care in America: A Must-Read

I’m not a speedy reader, so it took me a while to get through “The Cost Conundrum,” a lengthy but fascinating and highly readable article that appeared in the June 1 issue of The New Yorker magazine.It explores the cost and quality of health care in this country and how it can differ greatly from one locale to the next and why. Don't worry; there are practically no numbers or statistics.The article is a must-read for any health care professional, most especially those nurses and doctors who have the power to decide what medical services patients receive -- or not.The author, Atul Gawande, is a surgeon and journalist on staff at Brigham and Women's Hospital and The New Yorker, and has written best-sellers. He served as an advisor to President Clinton, and graduated from Harvard Medical School. He has numerous degrees, including a master’s in politics, philosophy and economics, which is probably why he can examine health care from a perspective different from other physicians.After what I’m sure was months of talking to health care providers across the country, and citing the conclusions of various studies, Gawande points out that costs and outcomes vary highly and that more procedures do not equal better outcomes.He talks about the “culture of money” that exists in some medical groups, and concludes that “we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.”Partly to blame for high costs and not-so-great outcomes is that “many physicians are remarkably oblivious to the financial implications of their decisions,” Gawande maintains. “They see their patients. They make their recommendations. They send out the bills. And, as long as the numbers come out all right at the end of each month, they put the money out of their minds.”I saw an example of this firsthand recently.A relative – a 30-something woman whose husband recently lost his job and their health insurance – had a lot of pain in her left leg below the knee. Turns out she sustained a stress fracture of the tibia, which was diagnosed by an orthopedist who took X-rays. Then he said he’d really like to get an MRI, too, “to get a better look,” but regardless of what he saw, the treatment was to be the same: no weight bearing for eight to 10 weeks.The woman questioned the need for the MRI since it wasn’t going to change the treatment, and because she’d have to pay for it. In the end, she had the MRI at a cost of $1,000. She was upset because no one could give her a solid reason for having the MRI, but went ahead, fearing something terrible might happen if she didn’t.The side story: In calling to compare the prices of an MRI, she found huge discrepancies. One free-standing facility charged $500; the local hospital charged $2,339. The reason? “The hospital operates on a different business model.”And why this woman paid $1,000 instead of $500 is a long story that includes the confusing and frustrating process of applying for Medicaid.Gawande cites many examples of practices like the Mayo Clinic that focus on what is best for the patient. Mayo, he points out, is “among the highest-quality, lowest-cost health-care systems in the country.” While visiting there, he saw real team effort in caring for patients -- "doctors, nurses and even the janitors” who sat in weekly meetings “working on ideas to make the service and the care better…”There is so much more to this eye-opening ,7,000-word feature, which you can read at http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande). You’ll see that Gawande is not pushing for socialized medicine. What he does suggest is funding research “that compares the effectiveness of different systems of care,” and establishing a national institute for health care delivery.He says we must bring together “clinicians, hospitals, insurers, employers, and citizens to assess, regularly, the quality and the cost of our care, review the strategies that produce good results, and make clear recommendations for local systems.”Read the article and tell us what you think.

The Problem With Health Care in America: A Must-Read

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