Reply #52: Fortunately for suffering humanity and unlike the OP, I am not a physician, [View All]

but I did read the article entitled The Cost Conundrum and a Dartmouth Atlas study entitled Getting Past Denial — The High Cost of Health Care in the United States published in The New England Journal Of Medicine (I'm assuming that is the Dartmouth study to which you refer). I doubt anyone would argue against best practices and wellness as factors in health care cost reduction. However, the New Yorker article seems to indicate that much if not most of the problem lies with nothing more arcane than a simple and perversely profit driven approach to medicine. The author rightly notes the admirable example of the Mayo Clinic's approach to cost reduction but then later states that:

"In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue." - Emphasis mine -

I confess I don't find it at all difficult to accept the author's contention on this point. Perhaps not most but certainly many clinicians would question change if the motivation for such change is other than profit. To be sure there are egalitarian physicians of noble spirit, some might even say medical realists with long views that see the entire system crashing if change does not come and come soon, such physicians who view medical practice as a calling to heal the sick and reduce suffering to the extent that is humanly possible. Human nature being what it is though, I doubt we can count much on such nobility of purpose for a solution to the health care crisis. As the author notes, we are witnessing a war for the soul of medicine in America - a war that is being played out among patients, doctors who are concerned for the welfare of those patients and doctors who are concerned about maximizing their incomes. The Mayo Clinic experiment might work on a broad scale at some future time when America is perhaps more socially enlightened, but single payer is an experiment already proven to work on a broad scale right now in every industrialized country in the world except the United States. Given the moral imperative of the millions of people in this country today who are either sick or uninsured and at risk and the looming medical economic disaster that awaits us, I really don't think we can afford to wait for social enlightenment.

The earlier mentioned NEJM article is also of interest not only because of its metrics that describe the regional factors affecting costs such as those cited in the New Yorker article; i.e., the Mayo Clinic model vs. McAllen, Texas, but also because of the required disclaimer at the end of the article for coauthor Elliott S. Fisher, M.D., M.P.H which reads:



Corporate money is too smart to deny that change is needed, but it quite obviously will never say such needed change should take the form of single payer. The stockholders would surely revolt; worse yet, they would sue.