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.
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