Atul Gawande. Health Care and Agriculture. An Intriguing Model.

Atul Gawande is at it again.  The Mass General Surgeon, policy expert and MacArthur genius, who turned many of our health care notions on their ears with his article on the vast, seemingly unexplainable differences on health care costs in the little town of McAllen, Texas, has some still further brilliant insights. 

He asks one very important question:  The health-care bill has no master plan for curbing costs.  Is that a bad thing? 

Gawande presents us with some very scary facts.  Over the next ten years, the cost of family insurance will rocket to $27,000 or more a year.  That's more than a fifth of every dollar earned, per family.  More significantly, spending will devour all future wage increases and economic growth. 

Here's the messy set-up for your thinking.  

So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.

Read more: http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande#ixzz0ZfPVIpMg

You'll learn, as many of us know, that pilot programs are the best way to deal with unexplainable problems about which we can see little resolution.  We test this, and we test that.  His use of brilliant analogy focuses on a similar problem we faced at 1900, American agriculture.  At the start of that century, agriculture was strangling the country, with more than 40% of wages going to paying for food. 

Well.  What's clear is that we have no choices outside of pilot programming a huge number of issues.  But, I'm not going to steal Gawande's thunder.  Check out the article for yourself. It'll be like his previous one on the Cost Conundrum, a national read. 

FYI:  For those who appreciate Malcolm Gladwell, Jerome Groopman (How Doctors Think, etc.,etc.) and now Atul Gawande, I highly recommend the New Yorker.  I've decided that I coffee with a select group of retirees (Uhhh.  I'm the non-retired one in the bunch).  Three of the eight of us regularly read the New Yorker and wouldn't miss it.  I don't get paid for this ad, but the low cost for such brilliance is ridiculous.