I know that I promised to stop obsessing about the U.S. health care system mess and get back to hard core endocrinology issues, but I read a very interesting article on health care that I need to tell you about. The article was published in The New Yorker January 26, 2009 and is entitled “Getting there From Here; How health-care reform really happens,” and written by Atul Gawande. The author should be known to you for his now famous piece, also in The New Yorker, entitled “The Bell Curve” (December 6, 2004). In that article, the author discussed why some medical centers are more successful in treating cystic fibrosis patients than other medical centers. As it turns out, the issues discussed in the article are relevant not just to cystic fibrosis but also to most other chronic medical conditions, including diabetes mellitus, an area of interest to me.
The author is an associate professor at Harvard Medical Schooland a surgeon and was a health-policy advisor in the Clinton Administration. The current New Yorker piece is a discussion of how health-care systems that could be described as successful (at least quantum leaps more successful than the system in the U.S.) developed in other countries. His thesis is that without exception, the successful health-care systems developed in highly pragmatic ways from existing systems rather than from approaches that totally scrapped the old to bring in the new. He calls such an approach “path-dependent” and implies that the U.S. would do well to learn from what others have done. He ends the discussion with a description of the Massachusetts plan which has built on existing health care system structures to markedly improve health care coverage but at far greater costs than anticipated.
The piece is well worth reading but I would urge you not to get overly enthusiastic about the Massachusetts plan as a potential road map for fixing what ails the other 49 states; as I have harped on over and over, any plan that does not address both access AND costs cannot be successful in helping the U.S. to get there from here. Nonetheless, Dr. Gawande has provided a road map of sorts that provides an important foundation for the path we will end up taking.
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