Atul Gwande’s Cost Conundrum

In “The Cost Conundrum,” his latest article for The New Yorker, staff writer Dr. Atul Gawande reports from McAllen, Texas, a border-town with the reputation of spending more per person on health care than almost any other area in America.

But higher spending doesn’t necessarily mean they provide better care, as Gawande discovers when he compares health outcomes in McAllen with those of El Paso, Texas — a city with similar population demographics, but where Medicare spending per enrollee is half that of McAllen.

Gawande writes that his findings, based on Medicare’s 25 metrics of care, indicate that, “On all but two of these [standards of care], McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.”

Atul Gawande’s article has become a must-read for all of us interested in health care reform. I personally found it shocking and impressive. Honestly, this is a great article, though it may be long, it really is important if you want to understand the huge cost issue at hand.

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A Diamond in the Rough of Health Care Systems

I have the opportunity of working for Intermountain Healthcare, which was mentioned by Pres. Obama when he said, “We have to ask why places like the Geisinger Health system in rural Pennsylvania, Intermountain Health in Salt Lake City, or communities like Green Bay can offer high-quality care at costs well below average, but other places in America can’t. We need to identify the best practices across the country, learn from the success, and replicate that success elsewhere…”

As we have discussed in earlier posts, the US health care system is a fragmented apparatus. However, within the clutter are some islands of outstanding health care. Intermountain healthcare is one such island that is able to deliver quality health care at a lower cost. The following CNN health video highlights some of IHC’s best practices.

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Requirement to Buy Insurance

Before reading the rest of this post please click here and read.

Why should citizens be required to buy insurance?


Imagine you own an insurance company, and the government requires you to cover everyone regardless of pre-existing conditions. Now, imagine that citizens have the choice of buying insurance or not.I am 25 years-old and healthy. I choose not to buy insurance from your company because I do not really need it. However, on my 26th birthday I am diagnosed with skin cancer. Now, I walk into your insurance company to buy insurance, and according to the law you can not refuse me because skin cancer would be a pre-existing condition. Is this fair to your insurance company? No.

If we mandate insurance companies to insure everyone regardless of pre-existing conditions then we must require able citizens to purchase health insurance. Otherwise citizens will have the incentive to purchase insurance only when they are sick, which would be unfair to the insurance industry.

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Obama Igniting Grass Roots Health Promotion

About two years ago, the Obama administration announced a contest that promised prize money for the best TV advertisement that promoted health care reform. The above video highlights the contest as well as the winner. I was impressed that the Obama administration sponsored such a contest. I think it encourages health promotion at a grass roots level. It helps citizens have a voice about health care reform.

The Obama administration is perhaps the most media savvy presidential administration in the history of White House. From campaigning heavily through facebook to igniting health promotion through YouTube, they seem to harness the power of social media.

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Health Insurance Exchanges Already Making Waves – Kaiser Health News

Health Insurance Exchanges Already Making Waves – Kaiser Health News.


I am sure you have heard of health insurance exchanges, but many of us do not entirely understand what they are or their implications. Some say that they have the potential to stimulate competition among health insurance plans; therefore, they may be able to lower cost.

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White House Reform Video

Although this video is a bit outdated, I do think Pres. Obama summarizes the feelings of most Americans regarding health care reform. Also, I am impressed that he takes a more objective role in motivating congress to come together. This video may help to remind us about what the goal of health reform is. Many Americans are against health reform due to the sole fact that a democratic president is the driver of this reform bill. Put aside your political party of choice, and ask yourself what does this country deserve? What kind of health care system provides cheap and fair health care.

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Health Models of the World: Wrap Up

Over about the last month, I have posted information regarding the major health care models of the world. We have covered the the following models: Bismarck, Beveridge, National Health Insurance, and Out-of-Pocket. You may be asking yourself, ‘so what?’ or ‘where does the US fit into these models?’

These four models should be quite easy for Americans to understand because we have elements of all of them in our fragmented national health care contraption. When it comes to treating veterans, we are like Britain or Cuba. For Americans over the age of 65 on Medicare, we’re just like Canada. For working Americans who get insurance on the job, we’re Germany or other Bismarck Model countries.

For the 15 percent of the population (and counting) who have no health insurance, the United States is like a underdeveloped country, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you’re sick enough to be admitted to a hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.

Short Case in Point:

While I have been working on my undergraduate degree I have worked at a local hospital in admissions and case work. Every day at work we have to tell three or four of our patients that they are welcome to stay in the hospital if they do not feel well, but their insurance will not keep covering their stay. Regardless of some of our patients medical issue, we often tell them that their insurance is only willing to cover ‘x’ amount of days for their respective procedures. However, we also have some patients who have great insurance that will cover almost as many days as they need. How unfortunate? How unfair?

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