Friday, June 12, 2009

The Problem of Modern Healthcare, pt. 1

The New Yorker recently had an article examining how healthcare in the US goes wrong. The article is a great read, in-depth and devoid of the classic free-market/single-payer argument that pervades the discussion of healthcare reform in the US today. Notably, the article focused on two separate methods of healthcare practice in the US. Healthcare in McAllen (in Hidalgo County), where average medicaid costs are $15,000/person, and the practices of the Mayo Clinic, which costs medicaid an average of $6,688 per person. McAllen also has some of the poorest health of anywhere in the nation, while the Mayo clinic is a national leader in quality. The fascinating part of the article is that these differences happen within the current free(ish) market for healthcare in the US, and they go against standard logic that more $ = better. Here's my breakdown of the salient points in the article:

The McAllen Model:
  • high doctor autonomy
  • doctors paid per service rendered, not salaried
  • extra tests/medicines incentivized
  • do the expensive thing by default
  • reliance upon patients with medicare = almost unlimited pool of money available to patients
  • patients always choose more services, assuming more = better
  • the culture of the doctors is very much medicine ==> wealth
  • as a corollary, doctors make millions and are the major landowners in the county
  • this is rather justified by the high initial costs of getting into and practising medicine
  • the other justification for such wealth accumulation, fear of/protection from malpractice lawsuits, isn't really a threat in Texas, where McAllen is located
The Mayo Model
  • doctors salaried, at a decent pay level
  • doctors paid in 6 figures
  • doctors work in concert as medical team, rather than as individuals
  • preventative medicine is offered more consistently, as doctors have no reason to want to do more expensive things later
  • wait to see if low-cost methods work before recomending expensive methods
  • patient-first healthcare considerations are emphasized
While this may seem obvious (profit-incentive for doctors doesn't equal good care for patients), it's a point that renders almost moot the debate over single-payer healthcare. (See part 2 of this post for a full excerpt explaining why).

It does, however, is present a strong case for doctors being civil servants (or quasi-civil servants, which I'll get into in part 3 of this post.

1 comment:

Charo said...

McAllen County? No such county in the Texas.