Atul Gawande, MDAs soon as you can, stop what you’re doing and devote 20-30 minutes to reading Atul Gawande’s important new article in the June 1 New Yorker, The Cost Conundrum: What a Texas town can teach us about health care.

I don’t claim to be an expert about cost issues but in my year-plus of listening to US healthcare discussions I’ve heard enough to know, from common sense, that it’s a big stinking tangled mess. The results are so dysfunctional that all signs indicate that the root cause must be perverse incentives. But the question is, where?

Every whichway you turn in these discussions people have a ready explanation for why they’re not at the root of the problem. Gawande appears to do a superb job of carefully selecting matched pairs of cities and situations to reveal whether the proposed issue does in fact make any difference. Care quality? No. Overall health of the population? No. And so on.

Gawande is a surgeon and a superb writer who knows his way around an argument. My gut says that from this moment forward nobody can claim to be well versed in health reform issues – and informed choice – if they haven’t absorbed this 7,800 word article.

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