A second blow to Atul Gawande (and Obamacare)

December 15, 2015- by Steven E. Greer, MD

Atul Gawande, MD, a surgeon working at one of the Harvard affiliated hospitals, wrote an influential essay in the New Yorker back in 2009, right as the push to get the ACA law (Obamacare) passed was beginning. He used the Medicare database as the irrefutable evidence to back up his emotional narrative.

His essay was lauded and became a key driver for the approval of Obamacare. It got Atul added to the A-list of the Democratic party. The caucus of Democratic governors invited him to be their keynote speaker. He made the TED talks circuit. He was on CBS News, etc.

Now, it seems that his assumptions in the essay were all wrong.

In the NYT today, they have a lengthy expose about how Medicare data models are irrelevant when it comes to real-world private insurance behavior. In fact, private insurance spending is often opposite to what Medicare is spending in the same regions. The NYT article states, “The experts were wrong”.

This is the second blow for Atul. His checklist system that seemed to work so well in poorly designed early studies was ultimately shown to be ineffective in a properly randomized study published in the NEJM.

But Atul Gawande is not the only Ivy League or elite college professor to have egg on his face as the ACA law stumbles along, poised to implode as spending skyrockets. MIT professor Jonathan Gruber was overheard on a hot mic admitting that they lied to the “stupid” Americans to get Obamacare passed.

Now, with extreme irony, the actual rank and file professors of Harvard are some of the biggest critics of Obamacare. The new healthcare policies forced upon them, with high deductibles and taxes on Cadillac plans, are causing them to rebel.

What is the real problem with American healthcare that is driving obscene costs even higher? It is the fee-for-service model that creates strong financial incentives to overutilize healthcare. Harvard’s own healthcare system, which has a virtual monopoly over the Greater Boston market, is the poster child for this problem, yet Atul Gawande has not written New Yorker essays on this scourge.

As Dr. Gawande’s own Partners.org grows by acquiring more and more doctor plans, the ability of health insurance companies to push back diminishes. The CEO’s of the “non-profit” hospitals have ballooned into the $10-Million-range.

Obamacare does nothing to curb fee-for-service, or any of the other flaws in the American health insurance model. This is why Obamacare exchange plan premiums are so high, that people are dropping out, opting for the $750 tax penalty instead.

Cynics have argued that all of these smart architects of the ACA law wanted it to fail, so that their dream of a single-payer socialized medicine could be realized. However, that would be giving them too much credit. It seems unlikely that Dr. Gawande or Dr. Gruber, back in 2009, were willing to be thrown under the bus and look like dunces in 2015, all for the sake of helping the greater cause.


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