Budget Director Orszag Takes Gawande’s Baton and Brings It Home

By  |  June 9, 2009 | 

Thanks to Brad Flansbaum for pointing me to Peter Orszag’s blog on Atul Gawande’s article (the subject of my previous post) on McAllen, Texas’s staggering healthcare costs. I’m not sure what’s more astonishing: the fact that Orszag read the Gawande New Yorker piece, the fact that he followed up on it with data analysis worthy of a JAMA paper, or the fact that he blogged about it openly and honestly, with no bureaucratic double-talk (yes, on www.whitehouse.gov!), even as he’s busy trying to save the universe.

In any case, read Orszag’s blog. It is awesome.

Only God knows if the Obama Administration will succeed in fixing our healthcare mess, but what a comfort knowing that there are highly competent people in charge of trying to get it done.


  1. Bob Wachter June 10, 2009 at 5:30 pm - Reply

    You’ve probably seen this by now — even more astonishing than Orszag reading and blogging on the Gawande article is the President of the United States making it required reading for all White House staffers and citing it in a recent meeting with Senators. All of this described in an article by Robert Pear in yesterday’s NY Times.

  2. dacox June 11, 2009 at 5:52 pm - Reply

    I guess this isn’t too surprising, but I was disappointed that the NYT reporting didn’t get into Gawande’s suggestion of the solution. Which has nothing to do with the top-down limits that the Congress-people appear to be stuck on. I guess the idea of limits is part of some other conversation. That’s a real shame. Too bad people are getting caught up in a quantitative perspective instead of getting into the qualitative dynamics (that Gawande addresses) of which the numbers are can be seen as lagging symptoms.

  3. ToddRowlandMD June 12, 2009 at 3:20 am - Reply

    The hero of this story is Grand Junction, Colorado. I feel fortunate to know one of the key players for this community, Dick Thompson. Several years ago Dick was asked to help the community enhance health care quality and to apply his considerable business experience.

    He helped to create Quality Health Network (QHN) which facilitates health information exchange and enhances communication via a secure electronic network that crosses organizations. It is no mistake that redundant and unnecessary tests have been reduced in this community.

    I am always more interested in the positive examples. Hopefully their will be followup analysis that identifies the tactics that communities like Grand Junction have applied to lower cost and improve quality.

    Todd Rowland

  4. DZA June 14, 2009 at 11:16 pm - Reply

    St Mary’s HR department has to be thrilled with this apparently well deserved press.

    /dusting of my resume
    //hospitalist service openings?

  5. KimTrampeMD June 18, 2009 at 3:42 pm - Reply

    The Solution to health care costs has got to include limiting the effect that litigation plays a role in how we deliver medicine. I was just talking to a Nephrologist who said he would love not to be ordering so many daily labs, but feels pressured to do so. The reality is that the hospitalist needs to not consult the nephrologist who then puts the 83 year old dialysis. Hospitalists are definitely going to be a big part of the solution, but they have to feel they are supported. I think this is a part that Obama doesn’t understand. When he spoke to the AMA, Obama calls on doctors, hospitals and other medical care providers to curb costs by reining in unnecessary tests and procedures. How ever in the same speech he said, “I’m not advocating caps on malpractice awards.” So many of the tests ordered on patients are hugely unnecessary, but are ordered because doctors are afraid of being sued. If we don’t take the lawyers out of the exam room we have no hope of changing physicians practices.

  6. jnmed June 18, 2009 at 7:00 pm - Reply

    Certainly fear of litigation has some effect, but capping awards is unlikely to rein in costs. Just look at the Texas example in Gawande’s article. Texas has a relatively restrictive malpractice climate, at least compared to NY where I work.

    It seems more likely to me that medical culture has fundamentally changed, and fear of malpractice is just one small contributor. We don’t know how to say “no”, or operate with uncertainty, or manage CHF without 3 echos a year, or evaluate syncope without neuroimaging. And we have no financial incentive to be judicious. Physicians are fundamentally no different than any other human- we are not frugal with other people’s money- even if the real expected impact on outcomes is miniscule.

    My friend’s 40 year old, perfectly healthy wife fainted in a hot stuffy room after a glass of wine the other day. The ED workup cost $2000, and they had to refuse admission for overnight tele, and stress test. I suppose the MD could claim “fear of litigation” drove me to want to admit- but I think this is more than that. We are afraid of uncertainty- and feel better with more test results- even if there is almost no chance it will change our outcome. Or maybe we own the nuclear scanner.

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About the Author: Bob Wachter

Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google. His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.


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