Monday, January 19, 2009

No, You Can't Get There From Here!

No, You Can't Get There From Here!

Is Atul Gawande, MD , surgeon, Associate Professor at Harvard Medical School, and acclaimed author reading my blog? No.

However, no sooner had I posted “You Can’t Get There From Here,” his article, “Getting There From Here,” appeared in the 01-19-09 issue of The New Yorker.

His article laboriously describes evolutionary 'path-dependent’ patterns that have led to national health plans in other countries and, will hopefully do so here.

He writes: “The overarching goal of health-care reform is to establish a system that has three basic attributes. It should leave no one uncovered—medical debt must disappear as a cause of personal bankruptcy in America. It should no longer be an economic catastrophe for employers. And it should hold doctors, nurses, hospitals, drug and device companies, and insurers collectively responsible for making care better, safer, and less costly.

All are noble goals for our disease-care delivery and re-imbursement systems that we can hope to achieve; but, once again, largely misguided, as they have way more to do with the economics of care and re-imbursement, than they do with true health-CARE reform.

Dr. Gawande writes: American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy.”

Keep in mind, all of that treatment, at a cost approaching 3 trillion dollars/year, for only 300 million Americans! ($10,000 per person per year, and rising! And, 12 prescriptions per year per person!)

The sheer numbers alone decry a failed medical model for health: failed any way you look at it, in terms of the rapidly increasing numbers of unhealthy and sick adults and children, in terms of the inefficacy of the treatments for them, and, in terms of the never-ending, skyrocketing, bankrupting costs associated with them.

The crisis is not one of care, but rather, a true health crisis because so many of us are so unhealthy.

The fix, the saving of lives and money, is in improved health, not in the care.

Sorry, Dr. Gawande, as I wrote in by blog: “You Can’t Get There From Here.”

1 comment: said...

Gawande, Atul,M.D. to me
show details 8:11 AM (1 hour ago)


Couldn't agree more that prevention needs to be a vital part of health systems. If you have a suggestion for which health system has succeeded best with it, would love to see it. But the VA and Kaiser systems have done a far better job on promoting health of its members than others. Haven't seen any that do it spectacularly well..