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Atul Gawande on the President's Speech

The doctor is in, and writing blog posts over at the New Yorker:

[H]e checked all the boxes on my list. And yet I remain concerned that he may not have done enough. ... Our current health-care system presents seemingly insurmountable difficulties. It is too big, too complex, too entrenched, bloated, Byzantine, and slowly bursting. What may be most challenging about reforming it is that it cannot be fixed in one fell swoop of radical surgery. The repair is going to be a process, not a one-time event. The proposals Obama offers, and that Congress is slowly chewing over, would provide a dramatic increase in security for the average American. But they will only begin the journey toward transforming our system to provide safer, better, less wasteful care. We do not yet know with conviction all the steps that will rein in costs while keeping care safe. So, even if these initial reforms pass, we have to be prepared to come back every year or two to take another few hard and fiercely battled steps forward.

In this way, successful reform will have to be more like a series of operations, with x-rays and tests in between to show how we’re doing. Embarking on the effort will be among the most severe challenges we take on as country. Outside the settings of war and economic collapse, we’ve never sustained any policy effort of this scope and duration. It is perfectly possible that our next push will be defeated, or used as an opportunity to dismantle the progress we’ve already made. But I can see no other choice. We can only forge ahead.

By Ezra Klein  |  September 10, 2009; 1:13 PM ET
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EXACTLY!! We are embarking on a long journey. We have a very sick patient here and one simple surgery ain't going to do all that needs to be done.

Posted by: scott1959 | September 10, 2009 1:49 PM | Report abuse

I like Gawande's use of medical metaphor, and upon reflection am surprised that this approach isn't being used more often in pro-reform rhetoric. One would think that you would be interested in drawing aesthetic inspiration from the subject matter at hand in order to clarify thorny or complicated issues for the general public.

Posted by: doxophile | September 10, 2009 2:39 PM | Report abuse

The crisis is not severe enough for most Americans to let go of what they have for an unknown they don't have yet. That's the problem with change that is deep and structural whether it is individual or societal. Too many people want to deal with this problem purely from a policy perspective or an ideological perspective.

Politics is about social psychology. And the president is right. We are not at a state historically or politically where the profundity of the crisis is at the point of total breakdown. But we are at a point where we can perhaps avoid breakdown by a process of evolutionary change when it comes to health care access and delivery. What he is proposing gives us a doorway into an evolutionary change, while perhaps avoiding total collapse.

Posted by: cmpnwtr | September 10, 2009 3:18 PM | Report abuse

cmpntwr is right.....people do not realize the extent of the crisis. They do not fully comprehend their medical insurance is only as stable as their job, they do not really understand the extent to which (in most states) insurers underwrite and thus would prohibit them from buying coverage, and they think that just because they have retiree medical no one can take it away.

Posted by: scott1959 | September 10, 2009 5:53 PM | Report abuse

I think many people do realize the extent of the crisis. (Also many others do not.)

I think a lot of people must see now that the health care system is badly dysfunctional, but they also see political process as a little dysfunctional too ;)

People are worried in general about the federal power getting this wrong, making wrong cuts with the scalpel. They know the operation has to happen sometime though.

I'm happy with the progress being made, the patient still breathes, and the operation continues.

Posted by: wapomadness | September 10, 2009 7:52 PM | Report abuse

What we REALLY need is to come to an agreement that our system really sucks and should be scrapped in favor of a completely new system. The new system should be one designed by Congress from scratch that they, themselves, must participate in and which affords not one of them anything better than anyone else.

Then maybe we'll adopt Taiwan's system.

Posted by: bcbulger | September 11, 2009 12:39 PM | Report abuse

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