Blank Check Medicine

I read this New Yorker Article by Atul Gawande today. It talks about the outlandish amount of money spent on healthcare in a small bordertown in the Southwest. In the end, Gawande's conclusion is that the reason this ridiculious amount of money is spent in this town is that the doctors there like to practice what I'm going to call blank check medicine. Instead of using some discretion in ordering tests and procedures in this community, the physicians have decided that doing is better than not doing. The down side is that the outcomes are not any better in this community. In fact, better outcomes seem to be found in places where less many is spent on healthcare. Just goes to prove, more is not always better.

Healthcare is a topic of furious debate right now, as President Obama continues to push for reform now or never. One of the major tenants of this impending healthcare plain will be cutting costs. No question we need to slow the amount of money our nation is spending on healthcare, but is all of this a "Buck stops here" situation? I'm sure that physicians can have a significant impact on how monies are spent, but it's hard for me to believe that writing a few less orders and doing less surgery is going to make the impact that we need.

I believe the major impact will come from spreading out the cost of healthcare. Right now, a major problem is the fact that only a few pay for everyone. Imagine if a person could go to the grocery store and get some food for free. Imagine grocery stores were required to have this food on hand at all times. On top of that, let's say that the grocery store owners were required to pay for this on their own. How would they do it? They would raise the prices of the rest of their food in the grocery store, effectively charging the people who came to the store to pay for their food for the free food. Now, superimpose that situation on American healthcare, and you'll see part of the problem. Health insurance premiums are astronomical. A large portion of small business owners in the country cannot afford to pay their employees, help to provide them insurance and still make a profit. The health insurers insist on making a profit. Don't get me wrong, if you run a business, you deserve to make a profit - but I believe every penny of our healthcare dollars should be going to healthcare. Imagine what we could do with this 42.5 million dollars.

I guess the point I am trying to make is that there isn't an easy answer here. Perhaps, we need to stop worrying about the money - and how much we are going to get paid - and look for a system that will allow us to take care of our patients. This isn't a situation where we can just remodel the kitchen and move into a new house and live happily-ever-after. This is a situation where we need to tear the house down, rip out the foundation and start from the ground up.