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Atul Gawande Goes Dining for Health Care

Cheesecake Factory Medicine?

by HELEN REDMOND

Atul Gawande.

Rock star surgeon.

I’d want him to operate on me.

If I needed an operation.

And I had health insurance.

He actually listens to patients.

And Gawande washes his hands. A lot.

To avoid Complications.

And to decrease nosocomial infections.

He wants to do Better.

Gawande wants to do what is right and to do it now.

Not wait decades.

The doctor uses a Checklist Manifesto before he cuts.

He practices medicine in Massachusetts.

Massachusetts Mandate.

You will be insured or you will be penalized.

Punished for not paying insurance premiums.

Gawande supports mandated market health care.

RomneyObamaCare.

Massachusetts forces people to shop for health care.

Go to the HealthConnector website.

Online shopping for a health plan.

Shop now or else!

Shop till you drop! Dead.

Shopping is fun. Americans love to shop.

So why not shop for medical care?

We shop for everything else.

A nation of shopaholics.

A nation of 50 million uninsured bargain hunters.

Choose between bronze, silver and gold health plans.

No silly, this isn’t the Olympics.

But there are winners and losers.

And it is a for-profit competition. For young adults, for the healthy.

Sick seniors. Let them have a single-payer, government funded health care program: Medicare.

Physically and mentally wounded veterans of wars?

Let them have a single-payer, government funded health care program: The VA.

Everyone else, get in the risk pool.

Put in zip code, date of birth.

Check if you want prescription drug coverage (it’s optional).

Click and start shopping.

Compare plans. Compare prices.

Monthly premium for Bronze Low Benefits Package: $346.

Monthly premium for Silver High Benefits Package: $492.

Monthly premium for Gold Benefits Package: $600.

$5000 annual deductible.

$25 office visit co-pay.

So many choices in the American health coverage marketplace!

Plan on paying premiums in perpetuity.

The good Democrat doctor Gawande agonizes over how to improve the dysfunctional American health care system.

His latest article for the snobs in black top hats at

The New Yorker:

“Big Med: Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?”

Cheesecake Factory.

About $15 for a main course.

Gawande had a great dinner there.

Hummus, a beet and goat cheese salad and miso salmon.

He wondered how an insanely busy restaurant that cooks over 200 menu items and bakes 50 kinds of cheesecake pulled it off.

So the surgeon spent time in Cheesecake Factory kitchens.

He watched happy, indefatigable Oompa Loompas prepare food from the same recipe with lightening speed.

Kitchen workers never deviate from the recipe.

And Gawande found out.

And then he had a wicked idea:

“We’ve let health-care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous. The Cheesecake Factory model represents our best prospect for change.”

Why does Gawande think the health care system should be run like the Cheesecake Factory?

Can I see a menu?

Mammogram, MRI, colonoscopy, chemo, craniotomy, crab bites, Cajun chicken, cobb salad, chocolate mousse cheesecake.

Dining out? A doctor visit?

Dining out? Dialysis?

No difference?

Check, please!

Assembly line medicine. A la carte blood work.

Pick two medication side dishes.

See more patients/customers in less time.

Turn over that four top and the exam table.

Treat ‘em and street ‘em.

Commodify. Quantify. Accountable care.

Speed it up!

The 15-minute doctor visit.

Better not be old with diabesity.

That just slows the system down.

Portion control the services.

Ration, delay and deny.

But big gulp, supersize the profits.

Because really, in the U.S.

We have Willy Wonka & the Chocolate Factory medicine.

You need a golden ticket to get in.

50 million Charlie Buckets don’t have a golden ticket.

But Gawande isn’t the first to compare food to health care.

1990s.

Richard Rainwater, co-founder, Columbia/HCA hospitals: “The day has come when somebody has to do in the hospital business what McDonald’s has done in the fast-food business and what Wal-Mart has done in the retailing business.”

Micky D’s medicine. Big Mac. Out-of-pocket stroke. HypercholesterolemiaFries. Drive thru deliveries. Fillet-O-Fish. Day surgery. Diabetes dollar menu. Deductible.Discharge. Mac Snack Wrap. Wallet biopsy.

McFlurry.

Better get out of the hospital in a hurry.

Unhappy meal.

Not lovin’ it!

Rick Scott former CEO of Colombia/HCA Corporation, current governor of Florida:

“Do we have an obligation to provide health care for everybody? Where do we draw the line? Is any fast-food restaurant obligated to feed everyone who shows up?”

No, we don’t have an obligation to feed everyone who shows up at a fast-food restaurant.

But we do have an obligation to provide everyone who shows up with health care.

Because people die if they don’t’ have access to health care.

Excess deaths.

Chocolate Factory.

Cheesecake Factory.

Hospital Factory.

But Gawande outs himself:

“As for the food [at Cheesecake Factory]—can I say this without losing forever my chance of getting a reservation at Per Se?—it was delicious.”

Per Se.

Fine French dining.

High-end gastronomy & Gawande.

Surgeons love to eat at $$$$ restaurants.

Especially when their favorite medical device manufacturer foots the bill.

Gawande’s lovin’ it!

Celebrity chef Thomas Keller.

French Laundry in Yountville, California

Per Se in New York City.

A nine-course tasting menu.

Cost: $295. Wine not included.

“Vichyssoise D’oseille.”
Smoked yogurt. “Bavarois.” Young radishes, sorrel.

“Croustillant d’Avocat.”

“Omelette de Fleur de Courgette.” Parsley leaf “Panade.” Cerignola olives and globe artichokes.

“Glace à la vanilla.” Tristar strawberries with sugar wafers.

Beautiful, complicated, innovative, vanguard, artisanal cuisine.

Attentive service. Time.

In the U.S., there are three tiers of dining in health care:

* Popeye’s for the poor and working class

* Cheesecake Factory for the middle class

* Per Se for the rich

Gawande needs to get out of American kitchens.

Spend some time in France with French chefs and physicians.

Who reject the idea that food or health care should be a mass-produced, factory commodity to be consumed in 15-minute increments.

For the French, health care and food are sciences and arts that everyone should have access to.

And that is why the food of France is celebrated and replicated the world over.

And that is why the French health care system is consistently rated number one in the world.

Why doesn’t the epicurean Gawande write a New Yorker article about that?

Helen Redmond writes about health care and the war on drugs. She can be reached at: redmondmadrid@yahoo.com

Her new documentary about health care is called: The Vampires of Daylight: Driving a Stake Through the Heart of the Health Insurance corporations. Website: thevampiresofdaylight.com