New Yorker: Atul Gawande on Cutting Health Care Costs


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Last week’s issue of The New Yorker features another installment in staff writer (and surgeon) Atul Gawande’s ongoing reports on the cost of health care. It’s called “The Hot Spotters,” and it’s well worth a read. Gawande looks at individuals and organizations who have already taken the initiative in meaningfully reducing health care costs by focusing on the surprisingly slim fraction of health care consumers — as little as one percent — who can drive a shockingly huge portion of total costs — as much as thirty percent. Profiling Jeffrey Brenner, a doctor in Camden, New Jersey who and took a statistical look at how health care was distributed across that city, Gawande writes:

“He found that between January of 2002 and June of 2008 some nine hundred people in [just] two buildings accounted for more than four thousand hospital visits and about two hundred million dollars. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers US$3.5 million.

“Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs — the people cycling in and out of the hospital — were usually the people receiving the worst care.”

It’s an eye-opening report that shows how fundamentally broken the health care system is in the United States. New Yorker subscribers can read the article online for free here, but others are locked out, unfortunately. As a consolation, Gawande’s highly influential 2009 report, “The Cost Conundrum” is also available and also completely fascinating.



  1. This was one of the best articles I’ve read in months. (His books are pretty awesome, too – especially _Better_.)

  2. Look forward to reading this. However any discussion of healthcare costs has to start with the 20-30% of costs wasted by private insurance companies.

    HC systems in other countries have an overhead of below 5% — and get better overall outcomes than our U.S. system.

    The reason (IMO for both) is the 1000s of insurance companies that spend 20-30% on advertising, CEO salaries, denying care, political lobbying. That’s our premiums that should be going to direct care.

    Even if 1 patient did “cost insurers $3.5 Million” (sic, since that’s nominally what an insurance company’s sole role is) that pales in comparison to the amount of money *any* U.S. insurance company spends on, say, advertising in a month or worse yet denying care. At least that $3.5M was spent on care.

    These anecdotes are important to the debate, but we shouldn’t lose sight of the real problem — private insurance companies that stand between us & the care every person in this country deserves as a human right.

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