Obama Says: Read Atul Gawande
I’ve already recommended Atul Gawande’s magisterial New Yorker article on health care costs, but now according to an article in a newspaper it seems that Barack Obama is recommending the piece to Senators. Of course I like to think that Obama actually learned about this stuff from OMB Director Peter Orszag who was illustrating the point with scatterplots before anyone ever put together a great piece of narrative magazine feature writing on the subject:
Long story short, high levels of health care spending are not associated with high levels of health care quality. The system is screwed up. If you want to read something longer than a New Yorker article on the subject, Sharon Brownlee’s Overtreated is also very good.
Also: Don’t you think it’s weird that I referenced “an article in a newspaper” but didn’t tell you who wrote the article or in which newspaper it appeared? Well, the newspaper article in question refers to Gawande’s piece as “a magazine article” in the first graf, and doesn’t get around to naming the author or the publication until graf thirteen, and since I have no intention of writing thirteen grafs it’ll just have to be a mystery.
26 Responses to “Obama Says: Read Atul Gawande”
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June 9th, 2009 at 4:07 pm
It’s clear from looking at Sotomayor’s face that she’s a long-term, heavy drinker.
June 9th, 2009 at 4:12 pm
Fitline? R-squared? Bueller?
June 9th, 2009 at 4:21 pm
..A little unfortunate that Gawande’s article, towards the end, says something to the effect that even a strong public option would not reduce over-supply. Perhaps he wrote it from a need to flex his bipartisan credentials.
Related note- he does not really demonstrate that greed (as opposed to fear, of say, litigation) is the driving factor. He writes something about a decrease in settlement caps to 250 K not having reduced cost, but it does’nt prove the point. After all, a young doctor starting on her career is equally afraid of making mistakes: 5mil or 250 K, either way *her career is screwed. Any data on this fear versus greed thing ?
June 9th, 2009 at 4:22 pm
Also: Don’t you think it’s weird that I referenced “an article in a newspaper” but didn’t tell you who wrote the article or in which newspaper it appeared?
Yes. And it’s weird and weirdly good that Obama was excited about the New Yorker piece which I had guessed they were writing about. I do remember Ezra Klein saying it was a near-perfect article on health care and highly recommending it.
June 9th, 2009 at 4:22 pm
Also: Don’t you think it’s weird that I referenced “an article in a newspaper” but didn’t tell you who wrote the article or in which newspaper it appeared?
Am I missing something? You linked to the newspaper article, so anyone with the motivation to move his/her cursor over the link can instantly see which newspaper it was. (I will refrain from naming that paper out of respect for the extremely lazy.)
June 9th, 2009 at 4:25 pm
“Fitline? R-squared? Bueller?”
Yeah, that would be helpful, but only in showing a really weak correlation. Eyeballing it, there seems to be a slight negative correlation between spending and results. And an R-squared so bad as to make the correlation meaningless.
June 9th, 2009 at 4:26 pm
For his next trick, spamtroll will diagnose Terry Schiavo via TV.
June 9th, 2009 at 4:26 pm
(Also, please note: I criticized the Gawande piece as scattershot and inconclusive in an earlier thread, and then later realized I’d only read half of it on a well-liquored subway ride. After reading the second half, I retract my earlier criticism and highly recommend the article to all readers of this blog.)
June 9th, 2009 at 4:28 pm
It’s clear to heavy drinkers that Sotomayor has a long-term face.
June 9th, 2009 at 4:41 pm
“Composite Measure of Quality of Care” means an adjusted combination of individual quality measures. As there are roughly 50 dots, does each dot represent a state, or maybe DRG’s?
Hmmm, what kind of variation might we find in nursing salaries, physician fees, and age of hospital facilities across the United States?
Data came from Universal Billing forms, Medicare Cost reports, and what other sources? People who use data should know the method used to compile it, also known as operational definitions.
The scatter plot is as useful as a “Who Flung Doo” chart. If this level of analysis is the basis for health care reform, America is in trouble.
This occurred post 2004, but the sale of two for-profit hospital chains added over $2 billion in annual interest expense? Where will that fit in future scatter plots? It won’t be shown, given the Obama team’s penchant for private equity underwriters (PEU’s).
June 9th, 2009 at 5:04 pm
“… high levels of health care spending are not associated with high levels of health care quality.”
Well yes and no Matty and as usual the truth is much more nuanced than your hyperfactional brain allows for.
Health care spending at Moffit is quite high, exceptionally so overall, but then the health care outcomes there are also exceptionally good.
Then we have places like Miami’s public health system where health care spending is relatively high yet results in fairly poor outcomes.
Hmmm, should we wonder if client population is relevant?
Oh I know, let’s compare Mormons and reservation Navajo shall we?
As many many brighter people than I have pointed out the article fails to even reasonably take into account much less correlate a host of factors.
However if you are happy to simply take from the article that higher health care costs do not always result in superior health care outcomes well Bravo Matty! and anyone who has ever had a bad experience with their personal physician will most likely join me in saying “Well Dohhhh!”.
But it does not follow that reduced spending can, much less will, yield better or even equal results across as broad and varied a patient population as America’s.
That point, which is the one I think you wish us to take away, is unproven by the article’s findings.
It is truly sad that ObaFuhrer is so shallow as to nonetheless seize upon that flawed deduction and actually wish to recommend such weak study to those charged with making health care policy.
Sad but not surprising.
Any port in a storm and all that!
June 9th, 2009 at 5:04 pm
“Am I missing something?” — James Gary
Yes. Yes you are. Matt is criticizing the author of the NYT piece for talking about Gawande’s New Yorker article without mentioning the name of the author or the publication until the 13th paragraph.
June 9th, 2009 at 5:12 pm
Seems like a lot of the power of that chart is tied up in how you measure something as complicated as “Quality of Care.”
Additionally, the x-axis is labeled “dollars”. Is this per person? Per patient? Total in millions?
June 9th, 2009 at 5:13 pm
The New Yorker article shows how little attention doctors and health executives pay to quality measures, of the specific kind. They focus on revenues, billing and take home pay. So how will layering pay for performance change anything? The focus will still be on what the doctor or hospital has to do to maximize the money. From the New Yorker:
…decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income.
This is clearly not the Obama plan.
June 9th, 2009 at 5:13 pm
I’m not sure why I am bothering to respond to JT’s inane ravings, but it’s clear from his comment that he’s never actually read the Gawande article.
You see, JT, if you had read the article you would know that it does not base its argument on a comparison of Utah to Miami, nor does it ignore demographic and cost-of-living variance. The article compares McAllen, Texas to El Paso, Texas. These two cities have very similar populations and health outcomes, but McAllen spends almost twice as much per patient. Before lecturing other people on “nuance,” you might want to try learning something about the subject.
June 9th, 2009 at 5:17 pm
No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs.
It’s not happenstance, according to Dr. W. Edwards Deming, once the world’s foremost quality guru. Higher quality means lower costs. Dr. Deming would excoriate the Obama plan, rankings, pay for performance, etc.
Atul Gawande should study Dr. Deming’s work. There is a multi-decade track record and may books chronicling his accomplishments. Profound knowledge is sorely needed and President Obama hasn’t a clue.
June 9th, 2009 at 5:24 pm
“We took a wrong turn when doctors stopped being doctors and became businessmen,” he said.
Texas has no CON law. That means anyone can build and operate any health care facility anywhere, anytime. If it’s someone with the power of the ordering pen, watch out.
June 9th, 2009 at 5:25 pm
All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.
The Obama health reform team is led by a for-profit insider. Beware, foxes are in the hen house.
June 9th, 2009 at 5:35 pm
If reading the Gawande article means wading through New Yorker-style details about the length of so-and-so’s beard, or how so-an-so taps his or her knuckles on the desk, or the color of so-and-so’s fucking car, well, no thank you, enough on this world routinely sets my teeth on edge as it is. I’ll let Mr. Matt fill me in the substance.
June 9th, 2009 at 5:37 pm
[...] » Awesome article on health-care in America in last week’s New Yorker. According to Yglesias, Obama’s been talking it up. Neat quote: Everyone agreed that something fundamental had [...]
June 9th, 2009 at 5:51 pm
someone@19: Always nice to see another vote for
pig-ignorance. You might be bored or irritated so you can’t be bothered.
If you actually were to take Matt’s advice on it,
he, like almost all the others recommending the article,
said:
“Too long and too good to except fairly – go read the whole thing.”
Are you a teenager who fears being bored while learning something.
June 9th, 2009 at 6:20 pm
I applaud the application of blogger discipline, but would recommend it be a bit more explicit. Hilzoy and Josh Marshall have had work essentially stolen by the mainstream press in the past, no doubt because they are ‘just bloggers’. In those instances I think charges of plagiarism are warranted. This was just sloppy and unprofessional. Atrios no doubt would judge it worthy of a blogger ethics panel, however.
June 9th, 2009 at 7:27 pm
#21: Oh, go eat a putrefying goat carcass. I read the article a week ago. New Yorker style still sucks.
June 9th, 2009 at 9:52 pm
Note that the system that is “screwed up” here is not the much-maligned private health insurance system but the main government insurance system (Medicare).
Explain again why I’m supposed to believe that government health care will somehow magically lower costs without hurting quality?
June 9th, 2009 at 10:56 pm
why do bloggers use inside newspaper talk like “graf”, “after the jump”, and “lede” so much? I don’t see those terms in the actual newspapers. Why not just use real words, like paragraph?
June 11th, 2009 at 12:41 pm
Gawande’s article is required reading. But who is Gawande? According to this article, he is opposed to single payer and is a frequent speaker at insurance industry events.
http://www.pnhp.org/news/2009/february/et_tu_atul_testc.php