Health Care Costs in the U.S.: Medicine as a business

If you are like me, you have an intense interest in the topic of health care in the U.S. and the prospects for reform. Undoubtedly, one reason is that we all have a personal stake in this. President Obama has put his campaign for healthcare reform in high gear, and is out talking and debating the subject.

Dr. Atul Gawande, of Brigham and Women's Hospital, has always been very instructive and readable through his books and articles. He has done it again with his latest piece in the New Yorker (June 1, 2009). He looks at McCallen, Texas, where healthcare costs are unusually high - the result of across-the-board overuse of medicine, that is of tests, referrals, operations etc. The article explains why the payer of health care, private or public, does not matter. It is the system of delivery that determines the efficiency and cost of medical care. The fee for service system is designed to increase utiliization, which leads to increased costs. Gawande points to evidence that more does not mean better.

It is a long article, but, in my opinion, well worth the time.