(image from the New Yorker.)
Mr Gawande lays out perfectly the perverse incentives that face doctors in the US. By examining the medical cultures in various cities around the US, he demonstrates that spending more on medical procedures, equipment, etc., do not produce better results. In fact, they can produce worse results.
But since doctors are paid (in most cases) by the number of tests and procedures they recommend, the cost of healthcare has grown completely out of control.
Mr Gawande goes further to show that the current proposals the government is considering to ‘check healthcare costs’ will not be effective:
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.
Definitely worth a read.