Paging Dr. Gawande For Rational Care

Rationing is the specter that scares plenty of folks away from even thinking about changing the nation's system of health care.

NPR's Ari Shapiro asks Dr. Atul Gawande, a surgeon and writer for the New Yorker, to explain how decisions about care get made. Gawande says the simplest sort of rationing based on a "fixed allowance of care" may be scary but won't ever be reality in this country.

He argues in favor of rational care, basing decisions on the best evidence. If implemented systematically that approach would help eliminate plenty of ill-advised procedures.

 

Take, for instance, CT scans, Gawande says. Performing 62 million of these scans in this country each year "is not just unnecessary and wasteful, it's dangerous." The radiation from the scans "produces tens of thousands of cancers" over time. Similar questions on appropriate use hang over other common tests that carry radiation risks.

More rational care would recognize that it's not smart to do CT scans for "ordinary headaches" and cut down on their use, Gawande says.

But can government be trusted to make the right choices? "On a scale of one to 10, I might have a five for confidence," Gawande says. But the health system today is like a patient with a "50 percent chance of death if we don't do something."

Better to start down the road of change, he says, and correct things as we go along than to do nothing.