Health Care Reform: A Doctor's Historical Perspective

Written by: Maureen Stabile on Apr 5, 2009 8:15 AM EDT

In concert with DFA's initiative for health care reform, I'd like to share an interesting article by Dr. Atul Gawande that was published in The New Yorker earlier this year:

http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande

In the piece, titled "Getting there from here," Gawande (a physician, author and professor at Harvard Medical School) examines the historical origins of the three principal models of universal health coverage in the world today. The government-owned National Health System in Britain began as an means to deliver medical care during the crises of World War II; people liked the system so much that they kept it in peacetime. The single-payer system of France, which offers public payment for privately-delivered health care, was built during the post-war period by expanding pre-existing, employer-based insurance funds financed through payroll taxes. (The Canadians created their own single-payer system gradually, starting in a single province.) Meanwhile, neutral Switzerland escaped the wartime devastation of its neighbors and came to rely on government-regulated, for-profit insurance coverage that is available to all citizens (Israel also follows this model).

The article contends that radical change is doomed to fail; instead, successful reform in health care or any other area builds and improves upon pre-existing structures. The United States already has elements of the three universal health-care models: government-owned (the Veterans Administration hospitals), single-payer (Medicare) and private insurance (usually employer-provided). The problem is that none of them yet comes close to covering everyone, but the opportunity for change is before us. Writes Dr. Gawande, "American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. … There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. 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."

##############

Tags: