The Poison Review

At the end of each year TPR eagerly awaits announcement of the Sidney Awards, honors handed out by David Brooks of the New York Times to recognize the best magazine essays of the year.  In naming this year’s winners, Brooks noted the importance of magazines in the health care debate, and called Atul Gawande’s New Yorker piece “The Cost Conundrum” the “most influential essay of 2009″.  In that article, Gawande — a Boston surgeon — sets out to determine why McAllen, Texas is one of the most costly health-care markets in the country.  He concludes — not really surprisingly — that this is the result of overutilization and a local medical culture that is fragmented, disorganized,  and dedicated to maximizing profits.  He points out that establishing a “public option” or a “single payer” would have minimal impact since such changes would not eliminate the powerful incentives towards more — not necessarily better — care.

In a fascinating  later piece, Gawande argues that although neither the recently passed House nor Senate Health Care Bill outlines a master plan for blunting skyrocketing medical costs, this is as it should be.  He compares the situation today concerning medical care to the status of farming in the early 1900s.  Medicine now, like farming then, is fragmented, disorganized inefficient, and threatening the country with financial ruin.  But in the 1900s — using a hodgepodge of pilot programs, effectiveness research, and (there’s no other term) community organizing — the farming industry was turned around.

Both articles are essential reading.