In 2009, Atul Gawande wrote “The Cost Conundrum” about how physicians in McAllen, Texas were making serious bank from running Medicare patients through extra tests, typically at facilities that they themselves own. “Overkill” (New Yorker, May 11, 2015) is a kind of follow-up. It turns out that the docs who previously ran up the huge bills now each get $800,000 from an Obamacare provision that rewards doctors who reduce the government’s costs.
[Separately the article notes that between 25-42 percent of Medicare patients per year get an expensive unnecessary test or treatment. Dr. Gawande says that our fancy machines are best at finding cancers that grow so slowly we’ll probably die of something else before they grow to become a real problem (the cancer is thus dubbed a “turtle”). Unfortunately they are not good at finding the fast-growing cancers (“rabbits”), which is why cancer death rates haven’t moved much.]
I read both articles cited because I am something of an Atul Gawande fan, being that he seems to have a better grasp of medical economics than most. Your summary of “Overkill” was worthy of Fox News in that you took an article on how managed medical groups such as WellMed encouraged by Obamacare are saving huge sums of money by eliminating unnecessary tests and procedures and enhancing care for more prosaic problems such as diabetes maintenance and pain management. A few doctors who previously ran up huge bills got bonuses some of which they share with their office staff. This is the most promising and optimistic article on Obamacare and medical economics I’ve read in hears, yet you, laser-like, zeroed in on the one sentence about the few people might be making an extra buck.
Brian: If you think “cutting” expenditures to 17.4 percent of GDP with substantial growth still forecast (see http://www.bea.gov/scb/pdf/2015/01%20January/0115_bea_health_care_satellite_account.pdf ) is an achievement for which American fans of Big Government should congratulate themselves, who I am to spoil the party? As noted in http://philip.greenspun.com/politics/health-care-reform , however, I like to look at what else we might have done with the fruits of 17.4 percent of our working hours (or at least 10 percent of our GDP if we were, for example, to cut health care back to the 7 percent that it occupies of the Israeli economy (see http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS )).
Israel a small country and medical profession is in high regard as way of helping people, following history of jewish doctors in shtettles treating poor patient of of their own pocket. Israeli doctors agree to make significantly less than their US counterparts. However, 7% of GDP eve too little for Israel.
” all is not well in a health system and protestors have claimed that they signify a system failure”: http://www.ijhpr.org/content/2/1/33
“Israel lacking enough hospital beds, says report”: http://www.jpost.com/Israel-News/Health/Number-of-hospital-beds-fails-to-keep-up-with-population-380004
Silver lining based on old research: http://www.bmj.com/content/320/7249/1561.1
Between this kind of stuff and Elon Musk’s projects, It’s beginning to look like: if you’re an entrepreneur and not extracting money from the government, you’re starting to look like a sucker.