The Fact of My Ignorance

Well its been a while hasn’t it?  Sorry about that.  I’ll be posting with more regularity in the future.  As many of you know I recently got back from an AMA conference in Chicago and it was a surprisingly eye-opening experience in a lot of different ways.  There’s no way I can cover it all in one post so I’m just going to talk about one of the issues that was discussed at this meeting.  There is a now-famous article that was recently published in the New Yorker entitled “The Cost Conundrum” which analyzes some of the drivers of high healthcare costs.

Everybody was talking about this article.  The President of the AMA called the article a “watershed moment” for healthcare reform.  Supposedly President Obama had everyone on his healthcare team read the article.  So if you have even a passing interest in healthcare policy and reform, you should probably read it too.  So for your enjoyment I’ve posted a link to it after the jump.

But first, a quick warning.  While I think this article is extremely important and talks about an often-overlooked issue driving healthcare costs, we should keep in mind that it brings attention to this issue by focusing on an extreme case.  The behavior of the doctors in McAllen TX discussed in this article is in no way typical.  They are identified as an unusual case in the article but its still important to keep that idea in mind.  And the way this is portrayed as almost the sole driver of rising healthcare costs near the end is a bit misleading.  I don’t think very many people studying the economics of healthcare would speak quite so strongly.  And finally we should keep in mind that this is not a new problem, but has been talked about by organized medicine for years now.  There are plenty of physicians who support the principles laid out in this article.  In fact some companies, particularly in California (Kaiser), long ago embraced the capitated model recommended by this author (there’s even a mention of Sacramento as a “low-cost city”!)

So my point is, this article rips a lot on doctors.  Some of it is warranted but it uses extreme examples and a bit of hyperbole to make its case, without really acknowledging the work physicians have already been doing for a while to solve this problem.  With that said it brings attention to an important issue and makes recommendations that I (and many other students and physicians) wholeheartedly support.  So with no further delay, your article awaits.

The Cost Conundrum by Atul Gawande

ps – its really long.

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