Unintended Consequences in Health Care Reform
Atul Guwande in the New Yorker via Sean Khozin
Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check [Guwande]
Gawande likes the idea of having integrated healthcare delivery systems, like the Mayo Clinic, where salaried physicians work in multidisciplinary teams and there is fair amount of collective thinking. As the CEO of the Mayo Clinic told him, “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing.” [Khozin]
The current system drives some absurd behaviors and incentives. I hope any upcoming reform builds within it, a way for continuous change. Any future changes will have unintended consequences. Fortunately, the fixes don't have to come all at once. Unfortunately it is very difficult to drive any positive change in the current system.
photo via docksidepress
