A couple things must be said before we get into this. One: The last thing I want to do is start a blog beef with health care thought leader and Boston physician Atul Gawande, M.D. whose thought-provoking New Yorker piece recently suggested that casual-dining chains like the Cheesecake Factory might offer a business model that could save American health care.
Two: It’s not me saying Cheesecake Factory food is bad for one’s health, it was former FDA head David Kessler, M.D., and a number of other nutrition advocates, as pointed out by health journalist Suzanne Gordon in a well-reasoned Boston Globe response to Gawande’s gambit. Gawande claims the food is “delicious,” a sentiment that might cause many readers – not just nutritionists – to roll their eyes.
Give some credit to Gawande for starting this whole debate. At least it’s put the complex bolus of health care economics – which is difficult to grasp, let alone remain awake to argue – into an easily digestible metaphor. But after that, it kind of breaks down.
You can see his point: Break down the processes of health care into simple hunks, sort of like service-oriented architecture in the IT world takes complex data flow and chunks it into small threads – and then hospital chains could serve patients just like the Cheescake Factory, California Pizza Kitchen and Outback Steakhouse do. Patients get a menu from which they can order their health care, and the economies of scale these restaurants enjoy could save health care from bankruptcy.
But just like the present iteration of American health care serves up unnecessary tests and procedures and has a lot of fat in its workflows, those chains also have a lot of fat, literally and figuratively. The incessant television, radio, billboard and Internet advertising those chains must buy in order to drive diners to our country’s finest concrete and asphalt mall-strosities isn’t free. If a hospital/health system chain were to emulate Cheesecake Factory’s model, the patients would have to pay for that, too.
Furthermore, anyone who’s eaten at one of these restaurants can’t help but wonder how personalized the meal really is…especially when customized orders either can’t be put in or are botched. Not naming names here, but here’s an experiment to try: Every time you order a sandwich at a casual dining chain, consistently substitute a bowl of veggies for the fries or other greasy potato-like product the menu mandates come with it. Some places will do that happily. Some refuse, but offer the veggies on the side for an extra charge. Still others just can’t deal, and say “no.” Try another one: Order a sandwich that has mayo or some variation of fatty white dressing as “very light, please.” You’ll probably still get two tablespoons squirting out the top of the roll half the time.
That’s where the whole argument for “health care casual dining” turns into another case of sour stomach. It’s an inconvenience, these menu trifles, when it’s dinner. When it’s health care, that’s a patient safety risk and a way to either increase the acuity of a health issue or prolong it. And the patients get to perpetuate the whole system by funding the pricey, soothing marketing campaigns behind them.
Here in Newton, MA – home base for both Gawande and SearchHealthIT – there’s a neighborhood, Auburndale that has a lunch counter, The Knotty Pine. The servers never roll their eyes or panic if you don’t want fries with that. They happily take care of you, and if you’d like, will help make your blue-plate special something that won’t appear in a future Center for Science in the Public Interest’s “Food Porn” column. It doesn’t cost an arm and a leg to eat there, in part due to the fact that there is no giant restaurant-chain overhead or franchise fees that need continuous financing.
That’s the model that could save American health care. Or something like it. That is, if the food analogies hold up. If not, just reach for the Tums and call us in the morning.