The author visits regions of the country where healthcare is very expensive, and places where it's very cheap. He hunts for sleazy healthcare executives who are intentionally over-utilizing, but he doesn't find them (or not too many of them). What he does find is lots of doctors:
Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.
This is a wake-up call for doctors. Those of us (and I'm looking in the mirror here) who like to blame insurance companies and drug companies for sky-rocketing healthcare costs --- we need to reread that paragraph above. He's absolutely right. We can blame PhRMA for making expensive drugs, but we can't blame them for writing the prescriptions. We can blame HMOs for denying the needed CAT scan, but we can't blame them for ordering the unnecessary scan.
Gawande concludes that all the insurance reforms and public plans will not solve our healthcare problem. Only when medicine returns to a patient-centered focus will we be able to control costs. Changing the culture of the medical profession is not just a lofty goal, it's an economic necessity.
To me, there is no more powerful argument than this for why the National Physicians Alliance exists and must continue to grow. Gawande connects something that even the most hardened conservative cares about --- the growth of healthcare costs --- to something that we all believe, the need to rebuild the covenant between patients and doctors.
I would urge everyone to read this article, or at least the conclusion. His way of framing the subject is the perfect tool to recruit supporters to our cause in general and our organization in particular.
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