Health care cost dilemmas

Caught up on my reading during the flight to Seattle, and last issue's New Yorker has a must-read piece about health care cost comparisons in Texas that gives one pause about whether we are having the right debate on the national level. One take-away from the piece is that the fundamental structure of the system is broken, at the caregiver level, when doctors own shares of the healthcare delivery system and often become financially incented to over-prescribe diagnostic tests and surgical procedures (simplified synopsis).

What fascinates is both the anecdotal and analytic evidence from various US communities presented by the writer---which shows how widely varying costs per community can be--- PLUS the key conundrum: as long as we have a medical system that allows physicians wide latitude to recommend and execute treatment plans in a world in which, after all, no two cases are exactly alike (which, I suppose, is generally a good idea), we will need some policing mechanism or financial oversight to prevent abuse. There's a strong case in the piece for untangling the financial web among doctors, insurers, hospitals, labs, and other diagnostic centers, but is this consistent with free market principles if we do??? Just what that mechanism should be is not clear, and there is a suggestion in the piece that the debate we are having about private vs. public insurance options may be largely beside the point.

You can find the piece here : http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande