Malcolm Gladwell Discusses Health Care in America with Forbes

Checking America’s Pulse

Malcolm Gladwell

In Malcolm Gladwell’s latest

book David and Goliath, the

New York Times bestselling

author applies the fable of

the man versus the giant to

today’s social structures and

institutions, and in one

instance, a single physician

attending to children suffering

from a deadly type of

leukemia versus the set

medical structures.

In the end, the physician bucked the notion that his lack of authority

made him disadvantaged, but rather, gave him the firsthand

experience to develop a successful treatment for childhood leukemia.

With the release of his book, Malcolm

Gladwell sat down for a rare interview

with Forbes contributor Robert Pearl to

get his take on health care in America.

Known for his astute insight into society,

politics, and government, Gladwell did

not disappoint with views covering a

wide range of topics on the intricacies

that make up American health care.

Here are the highlights from the

interview.

The Interview

The Affordable Care Act

Gladwell comes out the gate stating his

feelings about the Affordable Care Act

are mixed, in that he believes the Act’s

intentions are in the right place,

however, he is concerned if this is the

right approach – considering America’s

many challenges with health care

delivery.

Gladwell suggests a system that

values innovation for health care

delivery. This type of innovation, he

points out, would have to start at the

bottom.

America’s Health Habits

KNOW THE FACTS

34.9 percent of American adults are

obese, according to the Journal of

American Medicine.

Conditions relating to obesity, such

as heart disease and stroke, are

prevalent causes of preventable

death, states research from the

National Heart, Lung and Blood

Institute.

When it comes to Americans

maintaining good health, Gladwell

sees the issue as twofold:

1. There are very few incentives in the

current system to motivate people

to live more healthily.

1. There are also few incentives for

physicians to encourage healthier

lifestyles to patients in a fee-for-

service model.

As Gladwell sees it, the government is in the position to cultivate a system that

makes healthy living easier and puts the focus on preventative measures.

The High Price of Innovation

Gladwell believes it’s hard to compare

American health care to other systems,

such as his native Canada. The U.S. has

the unique position of being an

advanced medicine pioneer, which

comes with a high economic burden for

developing such technology.

Gladwell also points to America’s social

dynamics that need to be considered

within the system. A country with a large

standing army, and violent past,

America has an obligation to properly

serve its veterans, as well as incorporate

the underclass into the health care

system.

The Malpractice System

KNOW THE FACTS

According to a study in the

New England Journal of

Medicine, by the age of 65,

nearly a hundred percent of

physicians in high-risk

specialties had faced a claim

of malpractice; for low-risk

specialties, it was estimated at

75 percent.

KNOW THE FACTS

Not just open heart surgeons are subjects of malpractice claims, psychologists

and psychiatrists are susceptible too. A forensic psychiatrist may be called in

as an expert witness or consultant in claims of psychotherapeutic or

psychological/psychiatric malpractice.

Gladwell suggests the current malpractice

system does not adequately serve the

people involved since errors are often

directly related to the delivery of health

care, not just the individual physician.

His solution? Gladwell suggests we better

compensate those who suffer from errors

and address the breakdown in the system

as a whole, not just the singular error by

any one individual.

Government Regulations Gladwell sees government regulations as

strong in some areas, and over-bearing

in others. He points to the stringent

regulations for nursing-home care and

says the care is still not substantially

good. It could be, he says, because the

human element – the compassion – is

being squelched under all the

regulations.

On the other hand, he points to

regulations within pharmaceutical

manufacturing, which he says should be

voluminous in detail and not left to any

one individual's discretion. The process

should be streamlined and factories must

be inspected and investigated routinely.

Living with Dignity

KNOW THE FACTS

According to a study in the

Journal of the American

Medical Association, the

percentage of Medicare

beneficiaries who died in

hospice from 2000 to 2009

substantially increased from

21.6 percent to 42.2 percent,

respectively.

In discussing care over a lifetime, Gladwell says individual needs and type of

care considering the patient’s age and overall health should always be

examined.

Gladwell describes end-of-life care

focusing on dignity, compassion, and

attentive nurses, while the focus on a

young person in a car accident would be

a much more aggressive approach.

One way to look at it is, different resources

and practices for different stages of life.

For example, aggressive interventions may

not be in the best interest of elderly

patients who have long since suffered

from a multitude of ailments.

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All Slides: Forbes interview by Robert Pearl http://www.forbes.com/sites/robertpearl/2014/03/06/malcolm-gladwell-on-american-health-care-an-interview/ Slide 4: Obesity statistics http://www.cdc.gov/obesity/data/adult.html Slide 6: Malpractice statistics http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204310/ Slide 8: Hospice statistics http://jama.jamanetwork.com/article.aspx?articleid=1568250

Image Attributions

Sources

Slide 2: Image courtesy of Pop!Tech and Kris Krug through Flickr Creative Commons https://flic.kr/p/5wds2h

Summary With the release of his latest book,

Malcolm Gladwell sat down with

Forbes to discuss a range of topics on

American health care, including the

Affordable Care Act, the malpractice

system, and end-of-life care. These are

the highlights from the interview.