Less Is More: The Ugly Truth about American Health Care

I have been promising this post for a month. I’m sorry for the delay. I hope it was worth the wait.

A Health Care Crisis, More or Less

Last month, Atul Gawande—surgeon, professor, and journalist—published an essay in The New Yorker on the disparity and inefficiency of American health care spending, highlighting in particular the poor performance of McAllen, Texas. Gawande’s article rocked the policy world. The real news, though, is not the sad facts that Gawande brought to light, but rather the fact that it is considered news at all, for health economists have spent many years trying to wake up the media and the public to this state of affairs.

Gawande took a commonly accepted premise, “Americans like to believe that, with most things, more is better.” And then he shattered our happy little world, “But research suggests that where medicine is concerned it may actually be worse.”

Okay, it’s not that shocking. More has been the watchword of the last thirty years in more than just health care, and most of us recognize we haven’t exactly been well served by it. More, roughly speaking, is responsible for a housing bubble, a financial crisis, an unsustainably warming climate, and now a health care system that is making us sicker and poorer than most other industrialized nations.

But more isn’t all bad. Any economist will tell you that more is responsible for the unprecedented economic growth of the last century—and hence, the way of life we hold so dear. In fact, it is exactly the opposite of more that we fear the most. Open any newspaper these days, and you’re bound to find the word “rationing” at least once. Maybe we can accept that more is not always better, but in exchange, are we willing to accept…less?

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