POLITICAL observations & opinions

* healthcare … let’s do what works

Posted by Lew Weinstein on January 27, 2009

Atul Gawande writes in NEW YORKER …

  • Every industrialized nation in the world except the United States has a national system that guarantees affordable health care for all its citizens. Nearly all have been popular and successful. But each has taken a drastically different form, and the reason has rarely been ideology. Rather, each country has built on its own history, however imperfect, unusual, and untidy.
  • The 2003 prescription-drug program for America’s elderly aimed to expand the Medicare insurance program in order to provide drug coverage for some ten million elderly Americans who lacked it, averaging fifteen hundred dollars per person annually. 
    • The White House, congressional Republicans, and the pharmaceutical industry opposed providing this coverage through the existing Medicare public-insurance program.
    • Instead, they created an entirely new, market-oriented program that offered the elderly an online choice of competing, partially subsidized commercial drug-insurance plans. It was, in theory, a reasonable approach. But it meant that twenty-five million Americans got new drug plans, and that all sixty thousand retail pharmacies in the United States had to establish contracts and billing systems for those plans.
    • On January 1, 2006, the program went into effect nationwide. The result was chaos.
  • This is the trouble with the lure of the ideal. Over and over in the health-reform debate, one hears serious policy analysts say that the only genuine solution is to replace our health-care system (with a single-payer system, a free-market system, or whatever); anything else is a missed opportunity.
    • But this is a siren song. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. 
    • This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have. It won’t necessarily be clear what the final system will look like.
    • Massachusetts, where I live and work, recently became the first state to adopt a system of universal health coverage for its residents. It didn’t organize a government takeover of the state’s hospitals or insurance companies, or force people into a new system of state-run clinics. It built on what existed. The results have been remarkable. After a year, 97.4 per cent of Massachusetts residents had coverage, and the remaining gap continues to close.

LMW COMMENT … this is an excellent article that gets past ideology to a consideration of what is likely to work. President Obama, when he gets to healthcare reform, is likely to take this sort of pragmatic approach. We can help by pushing back against the “only my way is best” approach likely to be pushed by Democrats, Republicans, AARP, the AMA, the pharmaceutical companies, and many others.

Read the entire article at … http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande

Atul Gawande became a staff writer at The New Yorker in 1998. Also a surgeon, he completed his surgical residency at Brigham and Women’s Hospital, Boston, in 2003, and joined the faculty as a general and endocrine surgeon. He is also an associate professor of surgery at Harvard Medical School, an associate professor in the Department of Health Policy and Management at the Harvard School of Public Health, and the associate director of the B.W.H. Center for Surgery and Public Health


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