I highly recommend reading a recent New Yorker magazine essay if you want to better understand the massive issues facing healthcare in the U.S. The Cost Conundrum by Atul Gawande discusses the ethics of overtreatment, undertreamtment and profiteering at the expense of patient care. Click continue to read my notes from the essay. The biggest threat to our nation’s balance sheet is the cost of health care.

Nothing in medicine is without risks and one major cause of extreeme costs was the overuse of medicine.

“Nearly thirty per cent of Medicar’s costs could be saved without negatively affecting health outcomes if spending in high and medium costs areas could be reduced to the level in low cost areas” – Peter Orszat, the President Obama budget director.

Physician-owned hospitals can give physicians a temptation to overorder.

Healthcare as a means of improving health vs healthcare as a revenue stream to be maxamized for profit.

As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

On the totality of care: “Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.”