Battle for the soul of American medicine

Wow, what an article by Atul Gawande in the June 1 issue of The New Yorker.

He visits McAllen, Texas, "the most expensive town in the most expensive country for health care in the world."

There are dozens of vital themes in the article:

• Nobody there seemed to know that they were cost outliers.
• Everyone seemed to blame someone else for being cost outliers.
• Except one surgeon who said, "Come on, We all kow these arguments are bullshit. There is overutilization here, pure and simple."
• Doctors owning strip malls, imaging centers, surgery centers...with "entrepeneurial spirit." One surgeon said, "It's a machine, my friend."
• "Medicine has become a pig trough here," one surgeon said. "We took a wrong turn when doctors stopped being doctors and became businessmen."

Gawande concludes:

"Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world."

This is a must-read.