Summary of The Cost Conundrum

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The Cost Conundrum summary


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Atul Gawande has recently become CEO of a health care joint venture founded by Amazon, BerkshireHathaway and JPMorgan Chase. The surgeon, public health researcher and best-selling author believes that the skyrocketing costs of US health care are a result of medical systems’ incentive structures. To find out how Gawande came to this conclusion – and to learn what ideas may shape the way he fills his new role – getAbstract suggests you join him on a fact-finding mission to the border town of McAllen, Texas.

In this summary, you will learn

  • Why US communities with high health care expenditures often don’t offer high-quality health care and
  • Why providing the right reward structures for doctors is critical to bringing health care costs under control. 

About the Author

Atul Gawande is a practicing surgeon, best-selling author and staff writer for The New Yorker. In June 2018, he was named CEO of a health care joint venture owned by Amazon, Berkshire Hathaway and JPMorgan Chase.



The United States spends more on health care than any other country in the world. Rapidly rising health care costs are bankrupting millions of Americans and also threatening the fiscal health of the US federal government. The health care market in the border town of McAllen, Texas, provides a case study of the dynamics precipitating America’s health care cost crisis. The town’s per capita health care expenditures are the second-highest in the nation. El Paso County, Texas, in contrast, shares similar demographics and public-health statistics, yet spends only half as much on health care. Nevertheless, health care outcomes and the quality of care in both places are about the same.

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