Why U.S. Health Care Costs So Much
Are you afraid to admit you’re sometimes stumped when policymakers say “we need to control the cost of health care” or, “health care in the U.S. costs more than it does in any other industrialized nation,” or even why everyone says cost is the central reason for reform? I follow this stuff pretty closely but I must admit that I don’t really understand why this is the case even as I trust that it probably is the case. (I haven’t covered health care since the 1990s and I try to block it out. It was a complete circus.)
Enter Atul Gawande, a surgeon and a writer for the New Yorker, who takes us to McAllen, Texas, to explain in simple, clear, data-backed terms just how health care costs can skyrocket in one place even as they go down in another. [Below link to New Yorker Out Loud interview with the author.]
In this recent article, published for free online, Gawande lays out the whys behind the it of U.S. health care costs. Delving into Medicare data and other research, Gawande makes a strong case that higher health care costs (in the form of more tests, more surgeries, more procedures, etc.) lead to worse outcomes because of the increased risk to patients. He writes:Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.
He also raises an issue that few people, least of all Washington, D.C., politicians, want to talk about: for some doctors, health care is a money-making business.
Gawande writes that “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.”
The full article is illuminating. An interview with the author is online.
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