kitchen table math, the sequel: freakonomics blurbs the most expensive health care in the world

Saturday, May 30, 2009

freakonomics blurbs the most expensive health care in the world


Unfortunately, they leave out Gawande's central claim, which is that good health care costs less because good health care organizations place the needs of the patient first. Above the needs of the doctors, nurses, administrators, & c.

I would like to know how true this is of health care, broadly speaking, and I would particularly like to know how true this is of education.

If the needs of students were more important than the needs, wishes, and desires of the adults, would public education cost less than it does?

I think the answer is yes.

in a nutshell
  • Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen.
  • Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be.
  • The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible. THE COST CONUNDRUM by Atul Gawande THE NEW YORKER JUNE 1, 2009


Paul B said...

I think the costs associated with your conjecture would be difficult to ascertain. Classrooms are more like communicable diseases than individual illnesses so the costs disperse over a population and over time in ways that we just can't capture.

However, it is certainly true that we often focus on the needs of the 'system' (I guess that would infer adults) at the expense of the individual student needs. A few examples....

Kids that are way below grade level are fed curricula that is way beyond their ability to succeed with it. Why? The system gets measured on standardized grade level appropriate tests. Must feed the beast. These kids do not get the 'treatment' they need. They get what's perceived as important for the system.

Here's another. Chronic bad behavior does not often result in appropriate removal of the offender. Why? Suspension affects AYP, offending the system. The needs and rights of the good kids are made subservient to the offender's right to offend.

I'm sure there are more but you get the idea. The financial conundrum is that the inappropriate treatment of an individual 'pathogen' incurs costs that are born by the rest of the patients years later.

Catherine Johnson said...

There are certainly a zillion costs to the students in terms of lost opportunities & knowledge.

But just in terms of the money we pay, today, to support our local public schools there's also a question.

Here's an example.

My school uses balanced literacy to teach reading.

My school also has 5.5 remedial reading teachers for the general ed kids (not SPED).

My school has had Trailblazers for 4 years now.

This year, for the first time, we also have a full-time remedial math teacher in the middle school.

I believe these facts are causally related.

They're also expensive.

Anonymous said...

I actually read the book and I am a seventh grader, the best story I thought was the best is the story when abortion wasnt illegal and mothers started practicing it, the single mothers who didnt have qualitiy jobs never had children that grew up in a harsh environment that became criminals werent there so many years later i thought that was the wierdest thing.