America’s Required Reading: The Cost Un-Conundrum

Every once in a while, I read something so great that I physically react to the black and white pages.  I shake my head, or nod in agreement, or cry, or smile or speak out loud to myself.  When I read the seventh Harry Potter last summer, I sat straight up in bed and hunched over the last hundred pages in suspense.  When I read Gone With the Wind in high school, I wept almost uncontrollably.  And when I read The Cost Conundrum for class last week, I found myself nodding emphatically, muttering “yes!” and “that’s it!” while I highlighted, underlined, and scribbled in the margins.

It wasn’t the first time I had read Atul Gawande’s exposition on the cost of healthcare, but something struck me this time that hadn’t before.  It isn’t just that Gawande’s writing is – in a word – brilliant; perhaps best known for The Checklist Manifesto, the surgeon has proven before that his talents run both deep and wide.  The striking thing about The Cost Conundrum, then, is his ability to so infalliably present his message.  Gawande gives us a conundrum, but in 8 pages proves that it’s not such a terrible riddle.  He finds the answer somewhere in between McAllen, Texas and Rochester, Minnesota, and leaves it on the pages to be picked up by his readers.  It’s impossible to read his article and not coming away believing that there is a solution to the healthcare crisis in America, a solution that relies on collaboratively-focused accountable care organizations.

What is amazing to me is the way Gawande so clearly understands what we’ve been doing wrong, and simplifies it in to terms that every one can relate to.  He writes, “Activists and policy makers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks…. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician.  the lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care.  Otherwise, you get a system that has no breaks.  You get McAllen.”

And that’s why The Cost Conundrum should be required reading for Americans.  In a nation where 6 out of 10 citizens misunderstand health care reform, Gawande offers a straightforward, compelling glimpse into the national scope of the problem.  Perhaps if everyone took the time to read, to understand the patients-as-cash-cows and doctors-as-moneymakers model of McAllen vs. patients-as-people, doctors-as-health-keepers model of the Mayo Clinic, there’d be more educated debate on healthcare reform.


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