By Evan Falchuk
Over at The Health Care Blog, Matthew Holt riffs on my post about Steve Pearlstein”s web chat about health care reform. Holt suggests I have “veered towards the side of unreason” after reading Pearlstein’s column and webinar.
Holt is wrong. I veered towards the side of unreason a long time ago, and it’s great over here.
But seriously, Holt is one the true thinkers in health care, so I wanted to add a couple of observations.
Like an all-night dorm room conversation, health care reform conversations always seem to be about whether more government will solve our problems or less government will solve our problems.
It’s an abstract topic, so it’s easy to talk about. However, what gets lost in all the abstraction is the reality of what it’s like to be a patient, especially one that is sick and trying to get help from a doctor.
The brilliance of Atul Gawande’s article in the New Yorker is not his discovery that there is abuse in the Medicare system, as some would have you think. It was his observation that the causes of disparity in medical care and expense are much more complicated than they seem. Instead of being fundamentally about economics, they are fundamentally about how doctors and patients interact with each other. Being fixated of finances first and patients second is what got us into this mess. He thinks we should learn from the Mayo Clinic, which started a transformation 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.
Unfortunately, most discussion of Gawande’s article has been focused on the high levels of expense in McAllen, Texas. I don’t think this was Gawande’s point. In fact, the richness of his work is in his re-evaluation of his own assumptions on the subject and his conclusions about what it means for American medicine.
