Gawande v. Gladwell: Does health care have too many 'chauffeurs'?

Gladwell explains why health care has not emulated other industries, abandoned its chauffeurs

Topics: Payer and Regulatory Policy, Market Trends, Strategy, Recession/Downturn

June 26, 2012

New Yorker writers Atul Gawande and Malcolm Gladwell last week debated whether "the real problem with the health care industry" is that consumers lack decision-making power and are too reliant on physicians and other gatekeepers.   

Gladwell: 'Chauffeur model' is holding back health care

Speaking at the America's Health Insurance Plans (AHIP) annual conference, Gladwell—a book author best known for "The Tipping Point" and "Outliers"—stated that too many intermediaries stand "between the consumer and a (medical) service or technology." 

Gladwell contrasted health care with the auto industry, noting that when automobiles were first created, wealthy consumers hired chauffeurs because they did not know how to drive. At the time, chauffeurs had power because their customers needed them. However, the industry learned to let go of its chauffeurs.

However, Gladwell said that two processes that typically occur in industries that lose their "chauffeurs" have not occurred in health care: Commodification and consumerization.

He added that an unavoidable "step in any kind of technological transition is the acceptance of the temporary deficit in performance at the beginning in exchange for something else," but health care does not "have the same stomach for that period of transition." 

Gladwell said some innovations could help health care eliminate its chauffeurs. For example, he said the iPhone could significantly reduce the number of physician office visits.

Gawande: Focus on components, not chauffeurs, is health care's 'real problem'

Joining Gladwell on stage, Gawande—a Harvard professor, surgeon, and book author—rebutted the claim that health care consumers are harmed by the industry's many gatekeepers. According to Gawande, many industries that have chauffeurs continue to progress, such as teaching, police work, and firefighting. "Health care is intensely complicated. We can't perform our own knee operation," he said, adding, "We're all in the position of having to hire intermediaries or chauffeurs."

Instead, he pointed to health costs and the industry's focus on components as the "real problem" in health care.

Like Gladwell, he compared the health and auto industries, likening health care's focus on components to building a car with Porsche brakes, a Ferrari engine, a BMW chassis, and a Volvo body. "Put it all together and what you have is an expensive pile of junk that doesn't go anywhere because the pieces don't work together," he said (Gillepsie, Health Data Management, 6/22; Dick Tocknell, HealthLeaders Media, 6/25).

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Rating: | kenneth olshansky | July 5, 2012

Despite efforts to get a handle on the obesity epidemic , we as a society have been totally unsuccessful. The current day politics fight against any governmental intervention. As an example the soft drink industry continues to fight efforts to reduce sugared drink consumption. When there were efforts to change what was served in federally funded school lunch programs, there was political obstruction? Whenever Mayor Bloomberg attempts to set an example for healthier lifestyles, he is accused of creating a "Nanny-State". Dr. Gawande writes about "pin-pointing" care on those with chronic illness which makes a lot of sense. However I believe there is one major factor that is not being addressed and that is personal responsibility for ones health. Poor unhealthy lifestyle choices probably account for most of today's healthcare expenditures. All of society pays for those choices yet consumers have no "skin in the game" as it relates to costs. Whether you practice good health or not, there are no financial incentives or disincentives. That is the issue in my opinion. If insurers, employers and providers designed a system where everyone had a yearly personal health assessment and based on those risk factors , the patient would have to comply with appropriate "pin-pointed" medical regimens or have to pay a higher premium, ( or if successful receive a rebate) , then and only then will behavior change. Companies across the U.S. such as The Cleveland Clinic have had similar programs with encouraging results. Talk is cheap but healthcare costs are not !!