A Contrarian View of Health Care Reform

Imagine an America in which more than 40 percent of a family's income goes to a vital necessity.  It is not health care today, it was food in the year 1900.  At that time, over half the American work-force was engaged in agriculture, which consisted of numerous inefficient farms with low crop yields.  The high cost of food kept us a basically poor country.

Today, food accounts for only a small portion of our budget and labor force.  How did the United States achieve such a dramatic turnaround?  In a brilliant article in the New Yorker, surgeon and author Atul Gawande describes how the federal government did not impose a grand solution by decree.  Instead, the government created a series of pilot programs that showed farmers -- who held a deep-seated fear of change -- better farming techniques from local representatives of the Department of Agriculture.

Our dysfunctional health care system is now strangling our country in the same way that agriculture did over one hundred years ago.  Gawande's article details how "health-care spending will essentially devour all our future wage increases and economic growth."

In an op-ed piece in the Washington Post, columnist Ruth Marcus complains that current health care reform legislation focuses solely on expanding coverage and does nothing to curb these rising costs.  Gawande disagrees.

Gawande contends that there is no over-arching technical solution to spiraling health care costs.  "Nobody has found a master switch that you can flip to make the problem go away."  Gawande states that "much like farming, medicine involves hundreds of thousands of local entities across the country ... [providing] complex services for thousands of ... medical issues... The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front."

Gawande points out that the current Senate bill authorizes a multitude of programs to test different ways of curbing costs and increasing quality.  "Government has a crucial role to play here -- not in running the system but guiding it, by looking for the best strategies and practices and finding ways to get them adopted, county by county."

The debate over health care reform is heated. No single approach has garnered complete support.  Gawande has an interesting take on the complexity of the problem and his article is definitely worth reading.  While the cost of not getting health care reform right is high, the cost of inaction will likely be unbearable.

Words of Wisdom


My doctor gave me two weeks to live.  I hope they're in August.
-- Ronnie Shakes