The biggest changes? A dramatic rate of overutilization during a period that saw a marked expansion in physician-owned imaging centers, surgery centers, hospital facilities, and physician-revenue-sharing by home-health agencies. Home-health agencies there, for example, spent more than $3,500 per Medicare beneficiary—not only five times more than in El Paso, but also more than half what many communities spend on all patient care. In the end, none of the criticisms address either the pattern of overtreatment found in multiple studies of high-cost communities or the specific instances I found of revenue-driven care among doctors and executives in McAllen.
In other words: doctors have been poisoned by the "Culture of Money" (CoM).
And this is where I diverge. No one involved in the practice of medicine would deny that overutilization occurs to a sickening degree. My grievance with Gawande has to do with how he perceives the cause of the overutilization. He avers that it is all driven by the financial incentivization of physicians, exemplified by surgicenters and physician-owned radiology suites.
There may be some element of that in McAllen and elsewhere. But I see wasteful medicine everyday, and a great deal of it doesn't financially benefit the doctors who are most profligate. The problem of overutilization is, in reality, far more complex than the McAllen article would have us believe. Sure it would be a lot easier to use the tenets of the "Cost Conundrum" as a blueprint for repairing our broken health care system, but physician greed represents but a small piece of puzzle. Complex solutions make DC policy wonks uncomfortable. It can't be packaged into an intelligible sound byte. Physician greed, on the other hand, gives Peter Orszag et al a definable target, a "problem" to redress. In medicine and mathematics, often the simplest solutions are the most elegant. In this case however, we need to wade deeper into the morass if we hope to equitably solve our inefficient health care woes.