The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Dr. Gawande’s Radio Interview

Posted by Alan on June 17, 2009

There’s a chicken and egg aspect to health care reform which often frustrates lawmakers and policy makers. To achieve universal coverage the cost of health insurance must be affordable. To make coverage affordable you need universal coverage. So which comes first?

My take is that affordability has to come first. You cannot require people to buy something they cannot afford. When a pen is out of ink, all the regulations in the world won’t fill it again. This means the government has to make coverage affordable, most likely through subsidies of some kind. Subsidies are expensive And the budget, already groaning under the weight of the recession, two wars, an economic stimulus package, existing entitlements, and much, much more. Congress will be hard pressed to find the funds needed to provide the premium support required to get close to universal coverage.

Consequently, affordability needs to come first. This explains, in part, Director of the Office of Management and Budget Peter Orszag’s consistent focus on the as much as $700 billion in medical spending each year that goes towards services which do not improve health outcomes.  He began pushing lawmakers on this issue when he was Director of the Congressional Budget Office and he continues in his new role at the OMB.

The opportunity for health care reform to reign in medical costs received a substantial boost recently with the publication of an article in The New Yorker by Dr. Atul Gawande, a Boston surgeon who is also a staff writer for the magazine. Titled “The Cost Conundrum,” the article described Dr. Gawande’s exploration of medical practices in McAllen, Texas. That community spends more per person on health care than anywhere in the country with the exception of Miami, Florida which has higher labor and other costs. McAllen’s spending is twice that of nearby El Paso, Texas, even though the two areas have similar demographics and similar outcomes. The explanation, Dr. Gawande discovers, is the entrepreneurial culture of the community’s physicians. They maximize their incomes, but fail improving the health of their patients.

The article has been cited by President Barack Obama (who, it is said, has made the piece required reading for his staff), members of Congress, pundits and policy wonks. Few magazine articles have had comparable impact on the health care reform debate.

Those wanting to learn more about what he discovered in McAllen will enjoy an interview with Dr. Gawande  on Public Radio’s Fresh Air. During the nearly 30 minute segment, the doctor expands on his article providing insights from his own practice.

Dr. Gawande has made a valuable contribution to the health care reform debate by shedding light on the correlation between community medical practices, health care costs, and health outcomes. For anyone interested in health care reform, his Fresh Air interview is well worth the investment of time.


One Response to “Dr. Gawande’s Radio Interview”

  1. Dave Wood said

    Thank you Dr. Gawande for your input and dedication to health care in this great land.

    The main problem in American health care is indeed cost. And the two main drivers of high cost are 1. the fragmented, wasteful, inefficient system itself, and 2. the poor health of the American people.

    Therefore we must address both of these items to reduce cost. The problem with Obama care is that it only TINKERS with the existing dysfunctional system. And does very little to reverse the obesity, smoking, and poor lifestyle habits we now choose.

    The reason Obama chooses to tinker with the existing mess is because nobody has come up with a way to radically change things without scaring the bejesus out of the American middle clsss.
    Big change is not in the cards on a national scale, YET.

    The entire structure, from the employer pays private insurance model down to the for profit drug companys and massive government systems, are built on a system that is innately dysfunctional, wasteful and unfair.

    We will NEVER be able to change all the systemic faults in this system. There are too many to address. And the system is not capable of effectively changing peoples diets and poor habits.

    The private insurers won’t do it because there is no money in it. By the time the private insurer pays for a hundred members to lose the weight, 50 will drop out of the program, of those 50 that finish 40 will change jobs and coverage in the next 5 years and the private insurers investment will be realized by some other insurer.

    That is why I propose an idea I call the TWO BILL SOLUTION. It says that Congress would write two bills – the first written by the Democrats called the SPA Program (single payer authority) and the second bill written by the Republicans called the TAC Program ( total choice-private insurance based), THEN let the states opt into either program on a voluntary basis by way of a local election.

    In this way we may see Vermont or Oregon vote in the SPA Program and elect its own board to run it, and will self rule and self tax. Or we may see the fine conservative people of Kansas or Alabama vote in the TAC Program and would elect its own board to run it, and would self tax and self rule. In this way the states can finance what they want as far as investments into obesity or smoking reduction programs.

    These new SPA or TAC elected boards would know on a personal basis the leading CEO s of the large hospitals. And would know personally the leading Doctors in the state. IS NOT HEALTH CARE THE ULTIMATE LOCAL ISSUE?

    Congress has NO business in health care, other than veterans, national research funding, oversight, and gathering statistics. THATS IT!

    The details of how much a Doctor gets for an office visit is a local issue. Whether Doctor so and so over uses angioplasty should be dealth with through science and research by his or her peers, with the local SPA or TAC authority deciding what to do about it, NOT CONGRESS.

    You are dreaming if you think Obama care will actually slow down obesity and associated heart disease, renal disease, etc. History tells us that these big national programs are full of inept management, fraud and abuse, with poor oversight. For gods sake, the Congresss was told about the housing bubble, hearings were held, and the Democrats and Republicans voted to keep the subprime lending and borrowing through fanni and freddy going!

    The war in Iraq was voted for with little to no inquiry into the facts about weapons of mass destruction. They didnt bother to check! The Congress is not an institution that handles a local isssue like health care well. Its too slow, too big, and politics causes politicians to promise people that,”affordable, quality health care for all” is in the works. BALONEY!!! It aint affordable now, and won’t be after Obama care. Sure the Federal govt. will subsidize private insurance, but who pays that bill? Its a giant cost shift, courtesy of political promises.

    The TWO BILL SOLUTION is the answer.

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