http://voices.washingtonpost.com/ezra-klein/2009/05/atul_gawande_on_american_healt_1.htmlAtul Gawande on American Health Care
Ezra Klein
I'm jealous of Atul Gawande's article on medicine in America. I wish I had written it. I wish I could write it. But I didn't, and I can't. You, however, should read it.
It's the best article you'll see this year on American health care -- why it's so expensive, why it's so poor, what can be done.Indeed, it's good enough that I'm not going to quote from its core point because I don't want to try to summarize the piece. I want you to read it. But I will quote from a discussion Gawande has with a couple of physicians in McAllen, Tex. He's asking them why health costs in their county are so high.
“It’s malpractice,” a family physician who had practiced here for thirty-three years said.
“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.
That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?
“Practically to zero,” the cardiologist admitted.
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The Cost Conundrum
What a Texas town can teach us about health care.
by Atul Gawande June 1, 2009
Costlier care is often worse care. Photograph by Phillip Toledano.
It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.
McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.
The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”
The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.
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http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all