Monday, Jun 15, 2009
Today's Lunch Break:
The Cost Conundrum, by Atul Gawande
I started to summarize my favorite points from this piece, but I decided against it. Because...you need to read the article in its entirety [1]. It's that good.
Yes, I am a soon-to-be-medical-student, so naturally this is a topic of great interest to me. But I hope that by reading Gawande's article, you too are convinced that health care reform is the most important issue in America today, with great personal relevance to each citizen and with far reaching fiscal implications for our country. It is not an issue that can be solved with simple solutions, talking points, or finger pointing. I am beginning to see that the usual points of debate (i.e. private vs public insurance) are largely irrelevant to many of the fundamental problems. Like Gawande, I believe that we must lay aside ideology for empiricism if we are ever going to succeed.
Today Obama addressed the American Medical Association (and for the first time I followed live tweets [2]). There is much that could be said, good and bad, about Obama's speech, but I was happy to learn that he (President Obama) had also read Gawande's piece.
While I continue to worry about health care reform, that in itself is a reason for hope.
[1] When you're done with that, a great commentary on Dr. Gawande's article can be found here. An interesting take on Obama's speech can be found here. For more insights by Dr. Gawande, check out Better
[2] Yes, I am one of those users...and I read more about Twitter in tech news than actually use it.
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Comments
Comment Moderation is enabled. Your comment will not appear until approved.Secondly, McAllen is an outlier, an exception, an anomaly. That's why it was chosen for the piece. Medicine is not practiced like that everywhere!
Lastly, as a physician who has practiced in two other countries, I know that we do, actually, have the best healthcare system in the world. Healthcare is a three-legged stool made up of accessibility, quality, and affordibility. You can have two of the three. Pick which ones. No country has all three.
I appreciate your comments, although I respectfully disagree with your overall sentiment. My impression from talking with physicians, reading the literature, and having experiences as a patient lead me to seriously question the efficacy of our current system. I cannot respond to your points about the validity of the Medicare data, but I find the most compelling statistics to be those that are found repeatedly throughout the literature, such as the percentage of GDP spent on healthcare--a staggering and unsustainable number (and trend) no matter how you look at!
As far as the "best healthcare system in the world"...Perhaps for a shrinking minority, two out of your three stool legs are indeed being provided. But for far too many Americans, there is not a proverbial leg to stand on. We have a huge shortage of primary care physicians and increasingly long wait times in ORs, sharply rising premiums, and overall worse health outcomes as compared to other rich nations. And if you want anecdotal evidence, nearly everyone I talk to in America has a story, either from their life or a family member, of passionate frustration on this subject.
Since you are a physician, I respect your opinion very highly, but I would kindly ask you to substantiate your claims a bit. Having practiced in two other countries does indeed give you unique perspective--but not enough (forgive me if I sound rude) to convince me that the US system is superior to that of, say, Norway or Austria.
I am taking a Medicine and Management elective right now (Baylor has pre-clinical electives that are really cool, I'm also taking the history of medicine--fun stuff) and we've already discussed in class the idea of rational approaches to rationing...I promise I will expound more as I begin to formulate more definite opinions.
I wish I could write more on this, but I don't think I can encapsulate my ideas into any concise form--even if it is just addressing the points of Obama's earlier speech. I am definitely still listening and learning on this subject. Most of all, I agree with Gawande's sentiment that we need to look at this with hard data, try some things out, reassess what works and what doesn't, and tackle the problem from a pragmatic, public-health top-down perspective--not one driven by ideology (left or right), emotion (fear, joyful hope, etc), Glenn Beck, xenophobia (we actually DO have a lot to learn from our European neighbors, and Europe is more than just the UK or France), special interests, or political manipulation (though probably no way around that one).
You have a beautifully designed blog.
Cheers,
Evan Falchuk