Dr. Atul Gawande's June 1 piece on health care in the The New Yorker
, The Cost Conundrum
, has gotten the attention of policy-makers at the highest levels, including President Obama
So it's probably no surprise that the 3,000-seat Arlene Schnitzer Concert Hall downtown was nearly filled last night when Gawande spoke about healthcare reform.
Gawande, whose New Yorker
piece explored the wide cost difference of healthcare in different locales as a way to spotlight doctors' unnecessary services and high fees, told the Portland crowd that the need for reform is obvious and that we are the closest we have ever come to a vote on actual reform in both chambers of Congress.
“We know what we can be," said Gawande, director
of the World Health Organization's Global Challenge for Safer Surgical Care, Associate Professor of Surgery at Harvard Medical School, and Associate Director for the Brigham and Women's Hospital Center for Surgery and Public Health.
"We just have to have the political will to do it," he said "It's possible to care for people in rational ways, with high quality and low cost.”
As a means to achieve both high quality and low cost, he suggested paying doctors as teams, instead of by the services they provide. Other possibilities could be giving doctors salaries or bonus payments, as he emphasized that experimenting and learning from failure will be necessary.
He also said that for health care reform to work, there must be a “lifeboat” for people with no coverage, empirical data to understand if our system is working well, and a tax on high-cost plans. Despite the gridlock in Congress over health care, Gawande's speech ended with his belief that we are "on the cusp of becoming the most effective health care system in the world."