The Cost Conundrum

In Atul Gawande's article, "The Cost Conundrum," for the New Yorker, Gawande examines the peculiarities of McAllen,Texas a small border town just outside of El Paso which also happens to have the most expensive health care costs in the United States (sans Miami, a thriving, population gobbling metropolis). Kickbacks, pay days for more expensive tests, unnecessary procedures, unessential operations, anti-collaboration culture, all contribute to worsening health care in this example of the broken foundations in America's "health insurance" culture.

Gawande likens the current conventions of the industry to constructing a house with an independent electrician, plumber and carpenter, each paid by how many (respectively) outlets, faucets, and cabinets he puts in. Without a contractor to pull a team together and keep them coordinated, the house would be filled with unnecessary bits and pieces all unrelated to the house general well-being. Getting the country’s best electrician isn’t going to help, neither will changing the person who writes him the check (as certain members of congress would lead us to believe).

Hey, the last time I asked for a copy of my records from my endocrinologist the first thing she asked me was, "Is this to go to another doctor? Because there is a forty dollar fee." The "copying fee" mysteriously evaporated when I explained the GYN who recommended me never received a copy. The two doctors, by the way, have practices in the same medical office building, but have never spoken to each other. My GYN, in fact relies on me to relay information from the Endocrinologist.

NPR also covered the story in a broadcast, "Spend More Get Less, the Health Care Conundrum."