The Wrong Cure

I interviewed Atul Gawande many times when I was at MSNBC. He was a surgeon, a researcher and one of the most rigorous people I encountered while trying to understand American healthcare. I used much of his research as the foundation of the helathcare chapter of my book.

One of his story’s stayed with me.

Camden, New Jersey.

Researchers there discovered that roughly one percent of patients accounted for almost a third of the city’s medical costs.

The obvious conclusion might have been that these people were getting too much healthcare. Gawande showed me something different. They were getting the wrong healthcare.

Emergency rooms instead of primary care. Hospitalizations instead of prevention.

Procedures after people became catastrophically sick instead of help keeping them from becoming catastrophically sick.

So doctors in Camden tried something radical. They took better care of them. They identified the sickest people. Visited them at home. Helped them take their medicine. Coordinated their doctors. Dealt with the alcoholism, housing, obesity and other problems that kept sending them back to the hospital.

People got healthier. Costs fell. That was healthcare reform. At least that’s what I thought healthcare reform meant.

At almost exactly the same moment, Washington was having a very different conversation. Yesterday I wrote about taking the elevator upstairs at 30 Rockefeller Center to have lunch with Bruce Wasserstein during the financial crisis.

Bruce called what was happening the largest theft and cover-up in American history.

Then Barack Obama took office. The country had just experienced the worst financial crisis since the Great Depression.

People were furious.

There was enormous political capital available to ask who was responsible and change the financial system that had produced the crisis. Instead, Washington’s great political battle became healthcare.

I cannot prove that healthcare was deliberately chosen to exhaust the political energy surrounding the financial crisis.

But I watched that energy disappear into the healthcare fight.

And what made it harder to understand was that people like Gawande were already showing us what real healthcare reform could look like. Instead, Washington focused enormous political energy on forcing people to buy private health insurance from an unreformed monopoly.

(This is a clip from a 1 hour discussion withe Jen Perelman and Peter Hager last night on “Our Revolution”)

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The Affordable Care Act left private insurance at the center of the system and used our money in the government to subsidize it.

Americans were required to obtain coverage. Two historic crises. Two enormous opportunities for reform. Two systems filled with people demonstrating better ways to operate.

And the incumbents survived both.

That is why these stories from 2009 matter now. They aren’t history.

We are living inside their consequences.

The financial crisis left us with a country that no longer trusts its government.

The healthcare system leaves millions of Americans wondering what getting sick will cost them. And the lesson Gawande taught me in Camden still matters. The problem isn’t that we didn’t know how to do better.

We do.

The problem was what the system was designed to pay for.

Yesterday I wrote about the theft.

Today I’m thinking about the cover-up.

Maybe a cover-up doesn’t require hiding the solution. Sometimes you can put the solution right in front of everyone.

And simply choose something else.

This is the power of the political monopoly.