Health Care Chains

Atul Gawande, a surgeon at Harvard, has emerged as our most engaging and thoughtful writer on health care. He has a don’t-miss article in the current New Yorker in which he reflects on the trend in medicine away from private, stand-alone practice and toward large, standardized chains of hospitals and clinics employing physicians. (Did you know that only a quarter of doctors are self-employed today?) In it he compares these chains to The Cheesecake Factory, in a way that leaves you admiring the Cheesecake Factory for their advanced thinking. Corporate control and attempted standardization make up the face of health care change (reform?) that will proceed with or without Obamacare. It’s scary and hopeful all at the same time. Gawande gives you both sides, telling about his visits behind the scenes in both Cheesecake Factory restaurants and in hospital chains, and detailing his mother’s knee replacement surgery. It’s fascinating and subtle. Parts of it gave me the chills.

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