By Evan Falchuk

Writing in the New Yorker, Atul Gawande says we need to get away from focusing on who writes the checks in health care.  Instead, we need a health care transformation like that which the Mayo Clinic began some decades ago:

The core tenet of the Mayo Clinic is “The needs of the patient come first”. . . . Mayo promoted leaders who focused first on what was best for patients, and then on how to make this financially possible. . . . .No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs.

What is “core tenet” of national health care reform?

The President says it’s still cost containment:

But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.

The trouble is, we’ve been trying to control costs for 30 years, and haven’t even come close.  Meanwhile, our elevation of cost containment as our primary goal has distorted our system, creating problems like:

• More than half of doctor visits feature less than 15 minutes with the doctor

• Rates of deadly errors are as high now as they were in 1999

• Americans may be as unhealthy as they have ever been

Gawande is right when he calls the cost of health care a “conundrum.”  So, rather than rushing to put in place more cost containment – which decades of experience say won’t work – we should recognize that no matter what we do, health care is going to be expensive.  The more important question is this: what do we want our health care system to do?

Do we want it to be a giant cost-containment machine?

I don’t think so.  I think we want our system to be focused on making sure each patient is able to get the right care.  Like the Mayo Clinic system, our health care system ought to focus first on what is best for patients, and then on how to make this financially possible.  Maybe that this sort of system is more expensive than the one we have now, but at least we would be getting what we wanted for our money.

But if the experience of the Mayo Clinic is any guide, it might,  almost by happenstance, lead to lower costs.