Saint Fool
05-31-2009, 06:18 AM
The New Yorker has an interesting article (http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true) on medical costs in the US.
The reporter visited three towns: McAllen, TX. Rochester, MN and Grand Junction, CO. McAllen ranks second only to Miami in medicare expenditures, nearly $15,000 per patient in 2006.
One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.
Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.
“Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.
Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.
“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.
“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.
The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ”
The piece then turns to the Mayo Clinic and the medical system in Grand Junction, Colorado. In both places, doctors are salaried rather than paid by the procedure. Administrators, doctors, nurses and staff have focused on how expenses can be lowered without compromising patient care and what care is best for the patient. And in each place, the medicare cost is far less than McAllen's.
I'm recommending the article because it made me aware of the fact that the problem isn't so much health insurance and how the nation should pay for health care. It's the fact that there appears to be two different medical cultures in this country. One, like the Mayo Clinic, is focused on delivering quality medical care at a lower price. The other, like many of the medical businesses in McAllen, appears to be concerned with "how much can I make from this."
I'm not sure how you change McAllen to Rochester or any of the other cities mentioned as providing good health care for less money, but after reading the article, I think the "medicine as bidness" mentality is the biggest problem that's facing US health care. I'm not sure what kind of carrot Fed Gov or the states can use (tax breaks for those who lower costs without compromising patient care? Penalties for those who don't?) but the author makes a good case that if there isn't a cultural change, the situation isn't going to get better.
The reporter visited three towns: McAllen, TX. Rochester, MN and Grand Junction, CO. McAllen ranks second only to Miami in medicare expenditures, nearly $15,000 per patient in 2006.
One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.
Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.
“Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.
Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.
“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.
“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.
The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ”
The piece then turns to the Mayo Clinic and the medical system in Grand Junction, Colorado. In both places, doctors are salaried rather than paid by the procedure. Administrators, doctors, nurses and staff have focused on how expenses can be lowered without compromising patient care and what care is best for the patient. And in each place, the medicare cost is far less than McAllen's.
I'm recommending the article because it made me aware of the fact that the problem isn't so much health insurance and how the nation should pay for health care. It's the fact that there appears to be two different medical cultures in this country. One, like the Mayo Clinic, is focused on delivering quality medical care at a lower price. The other, like many of the medical businesses in McAllen, appears to be concerned with "how much can I make from this."
I'm not sure how you change McAllen to Rochester or any of the other cities mentioned as providing good health care for less money, but after reading the article, I think the "medicine as bidness" mentality is the biggest problem that's facing US health care. I'm not sure what kind of carrot Fed Gov or the states can use (tax breaks for those who lower costs without compromising patient care? Penalties for those who don't?) but the author makes a good case that if there isn't a cultural change, the situation isn't going to get better.