- Atul Gawande's "The Cost Conundrum", the most influential essay of 2009, investigates why McAllen, TX is one of the most expensive health-care markets in the country. Gawande writes, "When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen." He says, "We will need to do in-depth research on what makes the best systems successful—the peer-review committees? recruiting more primary-care doctors and nurses? putting doctors on salary?—and disseminate what we learn... we... need to fund research that compares the effectiveness of different systems of care—to reduce our uncertainty about which systems work best for communities. These are empirical, not ideological, questions." He holds up the Mayo Clinic model as an ideal in opposition to McAllen's model and calls for incentives to encourage that model: "The decision is whether we are going to reward the leaders who are trying to build a new generation of Mayos and Grand Junctions. If we don’t, McAllen won’t be an outlier. It will be our future."
- David Goldhill's "How American Health Care Killed My Father". Goldhill writes, "The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result." I disagree: while people should be given incentives to remain in good health, people should have some financial protection against accidents. (To friends who have thought more about this: this is your cue to comment.)
- Jonathan Rauch's "If Air Travel Worked Like Health Care", which, in Brooks's words, "takes the form of a customer trying to book a flight with a customer service representative."
* This is the first year I've been aware of them; I'm taking his word on it.