Who Owns Health-Care Cost Decisions?
The imperfections of our nation’s delivery of health care have long been recognized. From poor access for the underinsured and uninsured to potential overutilization by the worried well-insured, the issue has risen to political prominence, with its costs front and center. President Obama has called the rising costs of health care the “single greatest threat to America’s fiscal health.” As with most political issues, blame abounds—from the high costs of prescription drugs to physician fees and hospital costs. Efforts over the past decade to control costs, including reducing physician reimbursements, have failed to avert crisis. The result: less time with more patients and higher costs. Recognizing that we live in a capitalist society, other avenues for physician-generated income have emerged. In a recent New Yorker article (“The Cost Conundrum,” June 1, 2009), Atul Gawande, MD, MPH, examines why the costs of medical care in McAllen, Tex., are among the highest in the nation. The primary
Who Owns Health-Care Cost Decisions?