[ExI] USA Health Costs

BillK pharos at gmail.com
Mon Jun 1 09:11:07 UTC 2009

Good analysis here in the New Yorker magazine:

About fifteen years ago, it seems, something began to change in
McAllen. A few leaders of local institutions took profit growth to be
a legitimate ethic in the practice of medicine. Not all the doctors
accepted this. But they failed to discourage those who did. So here,
along the banks of the Rio Grande, in the Square Dance Capital of the
World, a medical community came to treat patients the way
subprime-mortgage lenders treated home buyers: as profit centers.

The real puzzle of American health care, I realized on the airplane
home, is not why McAllen is different from El Paso. It’s why El Paso
isn’t like McAllen. Every incentive in the system is an invitation to
go the way McAllen has gone.

When you look across the spectrum from Grand Junction to McAllen—and
the almost threefold difference in the costs of care—you come to
realize that we are witnessing a battle for the soul of American
medicine. Somewhere in the United States at this moment, a patient
with chest pain, or a tumor, or a cough is seeing a doctor. And the
damning question we have to ask is whether the doctor is set up to
meet the needs of the patient, first and foremost, or to maximize

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.

Long article, but good stuff.


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