In the Arena

The Wall Street Journal’s Cheesecake Fallacy

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There I was, reading Atul Gawande’s excellent piece about the future of medicine in the New Yorker, and thinking: hmm. Maybe we won’t need a major government presence in reforming the current, ridiculously wasteful system, maybe the free market will reform itself. After all, Gawande spends most of the piece showing how medical systems, which include groups of hospitals, are using electronic data-keeping and monitoring to achieve much better results for patients at less cost. The libertarian extremists on the Wall Street Journal editorial board will absolutely love this…but wait a minute:

There’s a long editorial about Gawande’s piece today in the Journal and they hate it. How could that possibly be? Because they categorize Gawande as a liberal bureaucrat-lover who wants government control of health care, as evidenced by his support for Obamacare (let’s leave aside the fact that the Wall Street Journal editors used to love Obamacare’s individual mandate, when it was the Republican alternative to Hillarycare in 1993).

But clearly, they haven’t read the piece. Gawande doesn’t mention the government at all. He talks about how the Cheesecake Factory restaurant chain achieves quality control in a large, nationwide system. It’s fascinating, but nothing new–it features the sort of inventory control and market research that consultants (like Bain, for example) have been promoting for the past 30 years. Then Gawande shows how several hospital chains in the Boston area are doing the same sort of thing to improve the quality of care and lower costs and, not coincidentally, produce higher profits. He uses the very specific example of his mother’s knee replacement, which is accomplished with less hospital time and cost (and pain, and greater mobility achieved more quickly) than her previous partial knee-replacement because the doctor involved has made a study of best practices.

Gawande also visits a intensive care unit control hub–a group of doctors and nurses monitoring patients on video screens, double-checking the work of the doctors and nurses on the wards–that provides more, indeed constant, attention to the patients and reduces the costs caused by mistakes and inattention.

In other words, the kind of changes Gawande describes are the kind of changes that the Journal has been celebrating throughout the American economy for the past 30 years. His piece set me to thinking that if all medicine ran this efficiently, we could save a lot of money and improve care dramatically, with a minimum of monitoring by federal regulators–and create a truly universal system of mandates and market choices, in which Medicaid and Medicare would cease to exist. This would combine Paul Ryan’s market vision with that of Peter Orszag and other Obamaites, who see electronic data and best practices as the way to achieve better, less costly care.

Let me reiterate in the simplest possible words: there is a way to solve our medical crisis that will make everybody happy (except for those who are feasting off the excess, unnecessary tests and procedures and hospital visits that are the cholesterol clogging our current system). Gawande has pointed a way toward that future that is happening now, naturally, through the free market system–and yet the Journal goes berserk because it perceives Gawande as a member of an enemy tribe. This is an exceptionally shoddy, myopic bit of business. The Journal’s ed board needs to check its medications.