The Spectacle Blog

Gawande and Friends

By on 8.28.09 | 9:50AM

Atul Gawande is back with another op-ed, but this one is co-authored with Don Berwick, Elliott Fisher, and Mark McClellanin the New York Times. His co-authors, all physicians, have done a good job in balancing his views. This time, the argument is not that we should all move to Rochester, MN and sign up for the Mayo Clinic. It is far more reasoned.

The authors say, “We have reached a sobering point in our national health-reform debate” in how to lower costs and expand coverage. “We have really discussed only two options: raising taxes or rationing care. The public is understandably alarmed.” They say we have to find a way to deliver care more effectively and less expensively, but “evidence that places like the Mayo Clinic in Minnesota or the Cleveland Clinic are doing it is likewise dismissed because their unique structures make them seem as far from Middle America as Sweden is.”

Well, thank you very much for acknowledging that Americans are justly apprehensive about what the social planners are up to.

In this article, the authors concede a lot. For instance, that Medicare data may not be representative of the entire population. More importantly, they look at ten different locations across the United States that seem to be doing a pretty good job. But each of these areas is doing it DIFFERENTLY. There is no one cookie cutter approach for everybody. They write, “In their own ways, each of these successful communities tells the same simple story: better, safer, lower-cost care is within reach.”

The one thing the authors fail to do is acknowledge that all of these areas are improving their systems under the payment system AS IT EXISTS TODAY! So, apparently massively changing the health financing system is NOT a prerequisite for outstanding care. Is it possible – just maybe – that what is needed is not some Washington-dictated massive health reform, but to allow and encourage innovation at the local level? As things are tried out locally, word spreads and other communities duplicate and improve on the model. That is how effective change usually comes about. Why not in health care?

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