Excerpt from letter/comment by Dr. Claudia Chaufan re Atul Gawande's article in The New Yorker

Re Atul Gawande's article this week in the New Yorker on the cost of healthcare in the US and how MDs are paid. Here is an excerpt letter written by Dr. Claudia Chaufan, M.D., Ph.D., Assistant Professor of Sociology and Health Policy
Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California San Francisco re Dr. Gawande's take:

"...A glaring feature of Gawande's article is that the author does a very good job of identifying what factors drive perverse incentives in US medical practice, i.e., the rather obvious fact that those who succeed financially are those who seek "profitable markets" rather than provide good care, and which ones drive good incentives, i.e., the alternative organization of doctors getting salaries in a "public-financing"-like arrangement, and being rewarded for offering excellent medical care (such as British physicians), both organizational schemes represented by the two cases and models he compares.

Yet he misses the evidence in front of his nose by concluding that for profit or non profit (public) financing does not really matter, and that the problem is about "doctors ethical consciousness" (or something like that), as if something in the DNA of American doctors' minds were fundamentally different from doctors in other countries.

Of course, why bother look at other countries? Had he done that rather than continue in the navel-gazing tradition of American health policy analysis, he would have learned how Britons' publicly financed health care system is able to reward good medical practice, precisely because of their public financing (in fact their practices are very similar to what his Mayo clinic folks do, even if in the context of our system the Mayo model is unlikely to survive).

What if, for instance, we Americans had ignored the Canadian discovery of insulin and its human application in 1921, and continued seeking solutions by comparing no treatment to Allen's "starvation diet" that, while clearly limited, offered patients a few more days or months of life, concluding that the diet, while not perfect, is the best we can offer to diabetic patients (even if few patients would comply with it)? Everybody would have seen the problems with this.

One wonders how many more will have to suffer, needlessly, until we achieve real solutions...."