True Costs

In last week's New Yorker, Atul Gawande (himself a doctor) tackles the issue of healthcare costs, and presents an interesting conundrum: how is it that the per patient spend for residents of McAllen, Texas, a poor border town, is one of the highest in the whole country? And does that mean that they receive better care? Bet you can guess the answer. We strongly urge you to read the entire article, but here we post a couple of intriguing snippets:

"The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine. This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen."

Why is this? Because at the Mayo Clinic doctors work together (without personal financial incentive) to coordinate the best treatment for patients. Not so in places like McAllen, where a more 'entrepreneurial' spirit presides. A memorable analogy from Mr. Gawande:

"Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check."

Incidentally, at the moment the number one article at the New York Times website is Nicholas Kristof's Thursday editorial on one American woman's experience with national health care in Canada. It is also well worth a lunchtime read.