Tuesday, April 6, 2010

“Now What?” asks Dr. Gawande

atul-gawande (photo courtesy of Reflective Design)

Atul Gawande, Brigham & Women’s Hospital surgeon, Harvard School of Public Health professor, and author for The New Yorker and other publications asks a simple question: AND NOW WHAT?

I once commented here on a brilliant piece by Dr. Gawande regarding the wildly high medical costs in McAllen, Texas and suggested that anyone who would like to become educated on this issue ought to read this particular work.  It’s illuminating and balanced and can be found by clicking here.

Now, given the passage of the health reform law and the mounting public pressure and likely political response to quash it, this physician author offers some perspective… and history… in the latest The New Yorker.  Here’s the link.


  • We have much to learn from the 1965 passage of the Medicare bill and the raucous build-up and aftermath.  Physicians, hospital and others were convinced it would be the end of the U.S.  It wasn’t.
  • The Patient Protection and Affordable Care Act (you know it as “ObamaCare”) could, in the author’s words, “prove as momentous as Medicare.”  But, there are some key differences:
    • The phase-in will be much slower this time
    • No key groups are specifically against it (as the docs and hospitals were in 1965); rather, this is about overall public opinion and political battling
  • The primary argument against the new law is that we can’t afford it.  Dr. Gawande suggests that the best way to “protect reform” is to prove that assertion wrong.  When Medicare came into existence, health care spending was six percent of the GNP.  Today, it’s 18 percent.  Left unchecked, we can’t sustain this continued increase and it will likely negatively impact our future economy in dramatic and harsh ways.
  • And here’s the most important point (and one I’ve made on this blog): the new law does not pretend to solve all the problems.  Rather, it creates new mechanisms and forum in which we can, together (and subject to public input and political processes) more effectively address them.

The anti-reform chorus continues to chant that this is about government takeover of health care.  But I see quite a bit in the package about public empowerment and private sector partnerships designed to fix what’s currently broken.

There may be good reasons to kill reform, but fear of a government take-over and ultimate affordability are not highest on that list.


  1. I just don't get it. Why do the Obamacare proponents, including Rey, incorrectly state the premise of the debate. They call the proponents of Obamacare "pro-reform" and the opponents of Obamacare "anti-reform" when they're not. The vast majority of opponents are FOR reform just not as defined in the bill. This bill is not what the majority of Americans want. Why doesn't it include tort reform? Because attorney's are being rewarded for their monetary support to the democratic party. Why is their a sweetheart deal in the bill for unions? For the same reason, payback.
    Before the current term is over my bet is that an initiative will be introduced to legalize as many "illegal" immigrants as possible. Why, not for the cause of helping people in need but to grow the base of the Democratic Party and add to the amount of people that are dependent on an ever enlarging government.
    The healthcare bill was created and passed because of political motivation, period. I am not defending the minority, they have their own political agenda. The problem is, the politicians of this country, for the most part, are out for themselves and are not looking after the people they represent.

  2. Dear Anonymous - thank you for reading this blog. Thank you for your comment. You stated: "The vast majority of opponents are FOR reform just not as defined in the bill." I think it all comes down to one question: is the present version of reform (tragically flawed as it is) better than doing nothing at all? Politicians and presidents have been trying very unsuccessfully to deal with the growing health care problem (lots of uninsureds and meteorically rising costs) without any success. Why? Way, way too difficult to take on politically. It's a bet the farm issue and the current President bet the farm. Looking through the (albeit narrow) lens of whether this package has any hope of dealing with those two issues, I'd say it does. Realistically, the alternative is not DIFFERENT reform. It's NO reform.