in mcallen texas, it's hunting season on scoundrels. dr. atul gawande investigates america's 2nd costliest city for health care (miami is #1, but somehow lost this opportunity for notoriety) and finds (the new yorker, june 1, 2009) that doctors are raking in profits by referring to labs and hospitals they own. america of course has so-called "stark laws" against kickbacks and self-referral, but why texas doesn't enforce these laws as strictly as boston, where dr. gawande lives, or the bay area, where i live, isn't a question that interests dr. gawande.
instead he compares the greediest private practitioners in mcallen to salaried staff docs at the best institutional practice he can find, the mayo clinic, and - by golly - the mayo docs are nobler! then dr. gawande concludes that private practice and what he calls fee-for-service billing (a mis-nomer as the mcallen docs apparently are actually gouging ppo's and medicare, not billing patients directly) are to blame for rising health care costs in america. one infers we'd do better forcing all docs to work in institutions.
hmmm...something's wrong with pitting the best clinic against the worst private practitioner...an unfair fight? non-matching study cohorts? shooting dick cheney in a barrel? apparently dr. gawande's mom was a private practitioner who saw lots of indigent patients for free. how about comparing her costs of service to the costs at the mayo clinic? then we'd have the best against the best; the solo practitioner would look pretty good. or let's put a mcallen surgeon in the ring against an institutional scoundrel - say richard scrushy of healthsouth. we'd have to hold the fight in shelby county jail, but both fighters would be equally dirty. i'll take scrushy by tko (head-butt) in the fifth round.
