Atul Gawande’s latest New Yorker piece, on lowering medical costs by giving the neediest patients better care, strikes me as a political Rorschach test.
To a progressive technocrat, like Gawande, the finding that one percent of patients account for a third of Camden, New Jersey’s medical costs presents a wonderful opportunity: by vastly increasing the amount of highly personalized social services these patients receive, we can reduce medical costs enough to more than compensate for all the visits and phone calls.
To a conservative (or libertarian), it raises the obvious question, Why are we spending other people’s money to help people who won’t help themselves? These “needy” patients are typically obese, with self-inflicted type II diabetes, and they need heroic measures to rescue them from a life of sugary treats and inactivity — exacerbated by their inability or unwillingness to check their own blood sugar and take their prescribed medications.
To an outright reactionary, it suggests the futility of taking responsibility for someone’s health without seizing any authority over their behavior.
To a tacit reactionary, it suggests the futility of taking responsibility for someone’s health without being able to turn them into a nutrient-rich mulch.