I was invited to participate in a public conversation last night with Atul Gawande, a surgeon who writes for the New Yorker on such things as the cost of health care, solitary confinement, and reducing errors in the ICU. What, you were busy organizing your sock drawer?
OK, so I really do think it’s fascinating stuff. Gawande makes it so — I learn interesting things every time I read his writing. And besides, I can’t help admiring his style and voice and the way he tells a story.
His third book, The Checklist Manifesto, is just out. It’s about adopting a simple intervention, a checklist, prior to surgery or in critical care, or other such clinical scenarios. He and colleagues have proven that well-constructed checklists save lives, and yet the hardest part may be convincing doctors to use them.
I’d love to see checklists created for patients to use. Patients are motivated to obtain appropriate health care — even more so than their doctors, I’m afraid — and we should make good on that energy.
You know and love Massachusetts as the state with (near) universal health insurance coverage for all of its residents. But their novel system is break-the-bank expensive, so the state is looking to overhaul how it pays for health care. Last week Massachusetts legislators proposed to pay doctors and hospitals a “global fee” to care for every insured patient, rather than paying for each test or service performed as is done now.
This would be a radical change to the health care business and would very likely change the way doctors evaluate and treat many of their patients. Today, doctors and hospitals are paid more for ordering more tests and providing more services, regardless of whether it’s of benefit to the patient. Under a “global fee”, the incentive would be to provide less care. Will that benefit patients? It’s much too early to say.
New data shows that a Seattle wet house — which puts street alcoholics in their own studios and lets them keep on drinking — saved Seattle taxpayers $4 million last year. These findings fly in the face of conventional wisdom, which assumes that homeless alcoholics need to be 100% sober before they can “handle” being housed. It’s the difference between expecting the alcoholic to conform to mainstream social norms, and meeting the person where he’s at.
The Seattle wet house is a real innovation in help for the homeless. For more on poverty, health care, and innovation, check out The House of Hope and Fear, coming this summer to a bookstore near you.