How the Senate bill would contain the cost of health care : The New Yorker

Gawande has a new article out on the health care bill

How the Senate bill would contain the cost of health care : The New Yorker

Dr. Gawande writes:

Turn to Page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is … pilot programs. … Where we crave sweeping transformation, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet—here’s the interesting thing—history suggests otherwise.

Gawande draws parallels to the history of American agriculture when the country slowly updated farming practices through a series of government-guided pilot programs. He argues that the health care bill will achieve the same end result, even though there is no one big hammer to control costs, just a lot of little ones.

Pick up the Senate health-care bill — yes, all 2,074 pages — and leaf through it. Almost half of it is devoted to programs that would test various ways to curb costs and increase quality. The bill is a hodgepodge. And it should be.

There is a danger in drawing parallels to other industries - I know that as a consultant - it is one of our downfalls when we try to draw a line with only one data point - but seems like an interesting parallel. Agriculture was their health care - a major source of the economy that needed a major overhaul to keep America competitive.

Regardless, I'm continually impressed by Gawande's thinking and prose.