The New Health Dialogue

David Sedaris; The New Yorker

Over at The New Yorker, David Sedaris has an amusing piece on his experiences with “socialized medicine.” It’s worth a read – if not for the humor, then for its helpful illustrations of concepts directly relevant to health policy.

Take, for example, this section:

The time before that, I was lying in bed and found a lump on my right side, just below my rib cage. It was like a devilled egg tucked beneath my skin. Cancer, I thought. A phone call and twenty minutes later, I was stretched out on the examining table with my shirt raised.

“Oh, that’s nothing,” the doctor said. “A little fatty tumor. Dogs get them all the time.”

I thought of other things dogs have that I don’t want: Dewclaws, for example. Hookworms.

“Can I have it removed?”

“I guess you could, but why would you want to?”

He made me feel vain and frivolous for even thinking about it. “You’re right,” I told him. “I’ll just pull my bathing suit up a little higher.”

While certainly a humorous tale, there are also several relevant kernels of truth for health policy. Most people wouldn’t blame Mr. Sedaris for wanting the tumor out – it seems, after all, a perfectly logical reaction for a patient. Notice his doctor’s response, however: “why would you want to?”

The doctor in this story could easily have said, “You’re right: let’s get it removed right away!” Mr. Sedaris, not knowing any better, would probably have gone right along with the program, and the harmless tumor would have been removed. Taken in aggregate, however, these decisions can generate significant costs without corresponding positive health returns. Sure, Mr. Sedaris would be able to wear his bathing suit as he likes, but the French government – or whoever insures his care – would have borne the cost for this convenience.

Similar situations occur every day in the US, with distinctly different results. Patients seem to expect care from their physicians, and doing nothing can seem like the exact opposite of care – despite the fact that it might often be the more prudent medical decision. Removing the harmless tumor or performing an unnecessary MRI  may not be worth the cost, and poses the risk that Mr. Sedaris might contract an infection or have some other complication. In aggregate, such care accounts for a not-insignificant chunk of America’s health care costs.

American medicine, therefore, might do well to take note of Mr. Sedaris’ cautionary – if humorous – tale, and start getting the country used to the idea that we might all be better of if doctors provided less care instead of more. If that means we all might have to pull our bathing suits up a little higher in support for Mr. Sedaris and his fatty tumor, so be it.