Thursday, August 20, 2009
# Posted 8:03 PM by Ariel David Adesnik
In June, New Yorker correspondent and practicing physician Atul Gawande profiled the town of McAllen, Texas, which has the honor of having the highest Medicare cost per patient in the nation. Healthcare costs are so high in McAllen because doctors there prescribe so many more tests and procedures (although there is no evidence this translates into additional health for their patients).
That's interesting, because neither party seems to be saying that the problem in America is that we get too much healthcare. The President says he will save hundreds of billions by eliminating waste and fraud, not by limiting treatement.
Why are doctors so interventionist in McAllen? In one word, the answer is capitalism. Doctors in McAllen have quite an entrepreneurial streak and seem to be interested in making as much money as possible. In other words, Gawande thinks President Obama may have been onto something when he suggested that doctors remove kids' tonsils just to make money.
Going further, Gawande argues that paying doctors by the procedure is why costs are out of control throughout the country, not just in McAllen. At the world-famous Mayo Clinic, which pays its doctors a salary, costs remain low even though the care is the best in the world.
Would it be so easy to duplicate that achievement on a national level? I don't know. Is it possible that doctors everywhere are too interested in money? I'm skeptical. None of my friends who've gone to medical are in it for the money. But misaligned incentives can lead good people to make bad decisions. Color me curious.
Cross-posted at Conventional Folly (8) opinions -- Add your opinion
We've all heard complaints from people who get their hospital bill and find that their doctor charged them for a consultation the morning he stuck his head in the door and said "how's it going today?" I've also heard news reports that people who go through the trouble of desciphering their hospital bills find questionable charges about 30% of the time.
The billing system seems assinine. If a doctor works for the hospital, then why shouldn't he be paid a salary? Instead of some sort of free agent scurrying about looking to pick up however much cash he needs to make his boat payment this month.
My complaint about helath reform is that they are doing it backwards. It failed last time, is failing this time, and will always fail if they continue to approach it from the standpoint of slapping together a huge complicated bill with huge unknowns and send out their minions to defend it.
What's so terrible about coming up with an outcomes list of what we wish to preserve or promote, then study the various healthcare systems of the world, have a public debate about how to acheive what we want, and then (and only then!) sit down and write an intelligent bill that reflects all the research and discussion?
Sure, it would take years and Obama wants to spend his political capital NOW! But my method will give a result sooner than Obama's and the result will be better while carrying less risk.
It is not a small issue we should take care of our health separately so then we can avoid treatments ...
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It failed last time, is failing this time, and will always fail if they continue to approach it from the standpoint of slapping together a huge complicated bill with huge unknowns and send out their minions to defend it.
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