Atul Gawande is a surgeon, public health researcher and a New Yorker staff writer. He was also recently appointed as CEO for the new joint venture for the companies of Warren Buffett (Berkshire Hathaway), Jeff Besos (Amazon) and Jamie Dimon (JP Morgan).
This venture is targeting health care. It is expected that this will initially be directed toward the employees of these organizations. They employ almost 1 million people worldwide.
Dr. Gawande is a prolific writer with 4 books and many essays to his credit. His subjects run from end of life issues, to examining errors in medical care, and the fractionalized way we deliver care in this country. He is an elegant writer who builds to his point with stories of individuals that personalize the topic for the reader.
One very striking article that he wrote is titled, “Is Health Care a Right?” As we face the dismantling of the ACA (Affordable Care Act, also known as Obamacare), this question becomes even more poignant. I highly recommend this article, but in the interim I am taking the time to report on it for the reader who won’t have the time to find and read the whole article.
Dr. Gawande introduces us to folks who have strong opinions about this topic. A pervasive sentiment centers around the work ethic and the fact if we decide that health care is a right, it “makes no distinction between the “deserving and the undeserving”. That felt perverse to Maria and Joe. Joe was an electrical technician, Maria an office worker. She was, that is, until she became too ill to work. Misdiagnosis took her to the brink until she finally found out the real cause of her illness and received treatment that eventually cured her. Their $6,000 deductible, premiums and copays totaled $15,000 annually.
When Joe later had an accident and was unable to work, they lost everything and had to file for bankruptcy. They saw this as a personal failure.
Many like them had strong feelings about recipients of Medicaid who they felt were undeserving- ones who had never worked and lived off disability. Yet they felt differently about Medicare, because this was something that they believed they had paid for and therefore should have. They did not see it as “socialized medicine”.
Dr. Gawande quotes Oxford Philosopher Henry Shue, who feels we are incomplete in our way of looking at “rights”. He argues that rights are as much about our duties as our freedoms. He explains that our right to physical safety has no meaning without our laws and law enforcement systems.
Further he believes basic rights that are part of the social contract include physical security, water, shelter and health care. He states that every social contract comes with a cost- and a cost-benefit analysis. Therein lies the rub. How much is enough?
Thomas Jefferson, who despite his strong belief in limited government, passed the Vaccine Act of 1813 with virtually no opposition, thus providing the miraculous small pox vaccine to anyone who wanted it- for free! Was that too much?
Water is becoming an increasing scarce resource. How will we determine who gets what? Simply on the ability to pay? Or who we find worthy?
The reality is that health care is not received or delivered equally in our country. Dr. Gawande feels that centering insurance in the employment market is a mistake. His conclusion is that the prospects and costs for health care in America still vary wildly, and incomprehensibly, according to your job, your state (geographical), age, income, marital status, gender, medical history and finally your ability to read the fine print.
He believes there are three areas of waste in the system: Administrative costs (too many middlemen), High prices (we pay too much for services), and improper usage.
He was not hired to simply negotiate with providers. He was hired to be a “disrupter” and look at long term solutions. I am impressed with much of his written work, so I am anxious to see what comes next from him in this new position. Don’t laugh too hard when I tell you that I have volunteered to be on the team!
