A few weeks ago, I wrote about Atul Gawande’s article health care costs.  Apparently, I wasn’t the only one who was impressed.  Gawande’s article has become a bit of a household name in the healthcare reform debate, and has caught the attention of President Obama himself.  Across the board, I’ve been reading positive reviews of the article, with many people echoing Obama’s sentiment that the problems Gawande outlines are the issues that we need to fix in order to reform our healthcare system.

But not everyone is a fan of the article.  I just finished reading an article by Evan Falchuk that takes a bit different view of the “McAllenization of health care reform.” Evan points out that the healthcare system is far more complex than any one town’s medical system, and that just addressing the issues that face McAllen won’t solve all of our problems.  Also, he notes that the government might be rushing the whole healthcare reform thing a bit, and that simplifying the problem by focusing so much on one town’s healthcare costs might make it easy to believe that a simple solution can be reached, and quickly.

Mr. Falchuk included a link to another article he wrote about how people are misunderstanding Gawande’s ideas.  This gave me a bit more insight into his views on the topic, but it left me scratching my head a bit too.  He points out that Gawande’s article highlighted the outstanding work that is done at the Mayo Clinic, where costs are low and outcomes are very good.  Compared to hospitals in McAllen, the Mayo Clinic is a beacon of good healthcare practices.  He goes on to note

“… instead of designing health care reform around ways to help more hospitals become like the Mayo Clinic, we choose instead to think about money, to focus our attention on how to cut costs in places like McAllen.”

I like Mr. Falchuk’s article.  I always appreciate a dissenting view, and someone who doesn’t just accept things because they are the popular ideas of the moment.  His article gave me pause to stop and consider the ideas that Gawande was trying to convey.  But I think that Gawande’s point – both about McAllen and about the Mayo Clinic – was that money is the central issue in both places.  In McAllen, money seems to have taken over as the primary pursuit.  I think that this is part of human nature, and is the most likely outcome in any situation where steps are not taken to specifically prevent it.  The Mayo Clinic is an example of an institution where money has not been allowed to become the primary pursuit.  Patient care has been deliberately elevated to a higher status than money, and the hospital has structured itself around this goal.  But without addressing the issue of money and taking steps to ensure that patients and quality healthcare come first, I think that the McAllen scenario is not an unlikely outcome.

I don’t see a disparity between making more hospitals like the Mayo Clinic and focusing on how to cut costs in places like McAllen.  I see them as two sides of the same story.  Until we address the underlying issues that create cost structures like we see in McAllen, we aren’t likely to be successful in implementing healthcare reform that models itself on the Mayo Clinic.  Maybe it’s a case of the glass being half-empty versus half-full, but either way you look at it, you have half a glass of water.

Mr. Falchuk’s article is part of the Health Wonk Review, which was primarily focused on healthcare reform this week.