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A Health Care Success Story [NYTimes.com]

It may have been the most influential magazine article of the past decade. In June of 2009, the doctor and writer Atul Gawande published a piece in The New Yorker called β€œThe Cost Conundrum,” which examined why the small border city of McAllen, Tex., was the most expensive place for health care in the United States.

The article became mandatory reading in the White House. President Obama convened an Oval Office meeting to discuss its key finding that the high cost of health care in the country was directly tied to a system that rewarded the overuse of care. The president also brought up the article at a meeting with Democratic senators, emphasizing that McAllen represented the problem that needed to be fixed.

Five years later, the situation has changed. Where McAllen once illustrated the problem of American health care, the city is now showing us how the problem can be solved, largely because of the Affordable Care Act that Mr. Obama signed into law in 2010.

 

[For more of this story, written by Bob Kocher and Farzad Mostashari, go to http://www.nytimes.com/2014/09...ype=opinion&_r=0]

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Originally Posted by Samantha Sangenito:

It may have been the most influential magazine article of the past decade. In June of 2009, the doctor and writer Atul Gawande published a piece in The New Yorker called β€œThe Cost Conundrum,” which examined why the small border city of McAllen, Tex., was the most expensive place for health care in the United States.

The article became mandatory reading in the White House. President Obama convened an Oval Office meeting to discuss its key finding that the high cost of health care in the country was directly tied to a system that rewarded the overuse of care. The president also brought up the article at a meeting with Democratic senators, emphasizing that McAllen represented the problem that needed to be fixed.

Five years later, the situation has changed. Where McAllen once illustrated the problem of American health care, the city is now showing us how the problem can be solved, largely because of the Affordable Care Act that Mr. Obama signed into law in 2010.

 

[For more of this story, written by Bob Kocher and Farzad Mostashari, go to http://www.nytimes.com/2014/09...ype=opinion&_r=0]

I see over utilization all the time. With things like press ganey reviews of doctors, doctors feel compelled to order more tests (but only for those who come in with insurance and demand them ) Folks who may need tests and treatment don't get them cause they don't come in.  I had two infants with RSV one was 9 months the initial admission was appropriate and the child only really needed to be in the hospital for oxygen 2 days max.  They had medicaid --- the family refused to be discharged until finally someone besides me spoke to them about how this was terribly medically unnecessarily.  They stayed 9 days.   At the same time I had a 2 week old with RSV but the parents had poor insurance with a high deductible.  They refused to have the baby admitted due to the high costs they would likely incur.  I begged them to let me admit that infant but I had no luck. Now I could have called CPS but they were very good and followed up VERY closely as an outpatient and the next day when the infant was obviously very much worse, they allowed me to admit the infant.  This is a mess. 

 

Having an open discussion with your doctor is very important but demanding tests of no value has several negative outcomes

 

1. It increased health care costs.

2. If you are a parent, you can medically traumatize your child i.e. you child has school avoidance due to bullying at school, has missed many days due to abdominal pain (which is real but the fix is stop the bullying).  The parent doesn't listen when you try to explain how important it is to reduce the stress in the environment so they demand a GI consult.  You have no choice but to acquiesce.  The child gets and upper endoscopy and a colonoscopy.  I think this is just negligent. 

3. An adult who demands more tests or medications could actually die due to side effects of medications or due to complications of the procedure. You want to help your health and instead you reduced your lifespan. 

 

Patients and doctors need to be partners but reasonable partners.  The mind is a very powerful thing.  The body is important too......

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