Clipboard: Will ‘Big Medicine’ bring better health or more bureaucracy?

By Chelsea Conaboy, Globe Staff

Dr. Atul Gawande explored the kitchens of the Cheesecake Factory for a recent New Yorker article about whether hospitals could learn efficiency and quality control from the restaurant giant while delivering a range of services that rivals the chain’s famously diverse menu. Gawande, a surgeon at Brigham and Women’s Hospital, acknowledges that the idea of building hospitals into mega chains is an uncomfortable one:

We have no guarantee that Big Medicine will serve the social good. Whatever the industry, an increase in size and control creates the conditions for monopoly, which could do the opposite of what we want: suppress innovation and drive up costs over time. In the past, certainly, health-care systems that pursued size and market power were better at raising prices than at lowering them. . .

Mixed feelings about the transformation are unavoidable. There’s not just the worry about what Big Medicine will do; there’s also the worry about how society and government will respond. For the changes to live up to our hopes—lower costs and better care for everyone—liberals will have to accept the growth of Big Medicine, and conservatives will have to accept the growth of strong public oversight.

In an editorial today, The Wall Street Journal criticizes the concept, saying supporters of the national health law signed by President Obama in 2010 don’t want consolidation because it will make health care more efficient but because it will give them more political control.

“This bureaucratization will amplify everything patients and businesses despise about the current system: the unintelligible $103,234.61 bill for a turned ankle, the doctor who can’t take a phone call because of how the hospital schedules shift,” it reads.

The editorial goes on to say that Republican vice presidential candidate Paul Ryan’s plan to give Medicare enrollees vouchers to spend as they please would make doctors and hospitals accountable to the patient rather than the government.

“Mr. Ryan’s insight is that health care would work better if patients were controlling their own dollars,” it says. “His reform accepts the fact that health, disease and treatment are usually complex, individual and unpredictable, not commodities that can and should be reduced to protocols, metrics, algorithms.”

I was struck by this last line. Is health care really so individual and unpredictable? Often it feels that way to patients, when we are awaiting results from a diagnostic test or needing personal attention from our doctor. But disease often follows patterns. Finding those patterns, applying protocols, and measuring the results is precisely the way that new treatments are developed and administered.

I would like to hear from medical professionals on this: What do patients gain or lose from made-to-order health care? What concerns do you have about what building bigger health bureaucracies?