The New York Times columnist David Brooks just came out with his Sidney Awards for the best magazine essays in 2009. I always read them because Brooks is among the very best writers/thinkers in journalism today. One of the award winners is “The Cost Conundrum” by Atul Gwande, the surgeon, author and MacArthur genius award recipient. Brooks describes Gwande’s essay as the most influential essay written this year. I highly recommend that you take the time to read it.
What I found especially interesting in Gwande’s essay is that he concludes that culture — or more specifically, the values of doctors — is at the heart of America’s heathcare cost crisis rather than who pays the costs. Gwande takes us to McAllen, Texas where in 2006, Medicare spent nearly $15,000 per enrollee, twice the national average, but achieved no better than average quality of care. Like a good investigative reporter he roots out the truth by conducting qualitative interviews and looking into quantitative data. He discovers that the average doctor in McAllen orders more procedures than the average doctor in America. Upon further investigation he learns that in towns like McAllen it’s a handful of doctors who drive up the cost per patient by ordering unnecessary procedures. He explains how these doctors benefit financially from ordering unnecessary procedures. The financial benefits come in the form kickbacks to admit patients to hospitals and revenue to partnerships of physicians who own diagnostic equipment such as MRI and CT-scans. He sums it up this way:
“When you look across the spectrum from Grand Junction to McAllen–and the almost threefold difference in the cost 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 revenue.”
In some ways, this is a matter of identity.