Summary of Atul Gawande’s “The Cost Conundrum”

Summary of Atul Gawande’s “The Cost Conundrum”

“This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse” writes Atul Gawande in his June 2009 The New Yorker article, “The Cost Conundrum.” Gawande is a staff writer at The New Yorker, redounded surgeon and associate professor at the Harvard Medical School. Additionally, from 1992 to 1993 Gawande served as a senior health-policy advisor to Bill Clinton’s Presidential campaign and to the White House.

The summer of 2009 was a heady time for health care reform in the United States. The newly elected President Barack Obama was eager to make good on his campaign promises for national reform. And only one month before this article was published, the US Senate Finance Committee held hearings on Health care reform. It should be noted that President Obama specifically cited Gawande’s article in discussions and in high-level meetings.

For this piece Gawande spoke to a small group of doctors whom all practiced medicine in the small town of McAllen, Texas. Why McAllen? As Gawande points out, McAllen tops the list of the nation’s most expensive places for health care. “In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But, since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than $10,000 per person.”

After some discussion, the doctors all seemed to agree that ‘overuse of medical care’ was the issue in McAllen. When treating a patient, doctors aren’t dealing with science in a lab; they must also consider the perceptions, feelings and emotions of their patients. Doctors must constantly reassure the patient that they are indeed receiving the most thorough and advanced care available. Doctors are ordering complicated (and expensive) tests and performing surgeries for ailments, which in the past would have been allowed to run their natural course.

But, doctor-patient relationships aren’t the only reason that ‘overuse of medical care’ has become the norm. Doctors want to protect themselves from possible malpractice lawsuits and it also doesn’t hurt that a doctor increases his or her paycheck with each additional test and procedure. When diagnosing a patient doctors in McAllen, and in countless other places, are increasingly over testing, over medicating and often performing unnecessary procedures.

Gawande consulted experts and private firms and they all agreed with the McAllen doctors. When compared to other cities in Texas and to cities nationwide, the patients in McAllen received more tests, treatments, surgeries and home care. But McAllen’s high costs aren’t necessarily bad, not if the results were that patients in McAllen were truly healthier than their counterparts in other cites with lower costs. But, studies find that in fact the opposite is true. Gawande writes, “… 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.” High costs aren’t necessarily an indicator of high quality care.

Gawande concludes by saying that true health care reform is not possible unless the issues related to ‘overuse of medical care’ are addressed. Controlling costs is key. Gawande is appealing to President Obama, politicians, doctors and the American public to look at the facts. If they do not any reforms will be doomed to fail.

Work Cited

Gawande, Atul. "The Cost Conundrum." The New Yorker 1 June 2009. Print.