Routine cruelty
Wednesday, January 28 2009
Atul Gawande’s article in the New Yorker has gotten a lot of play already, but here aremy two cents:
Gawande is correct that path-dependency will shape our future health care system; that much is more-or-less inevitable, by definition. But to some extent he’s arguing against a straw-man. I don’t see a lot of serious commentary suggesting we should scrap our health care system and start over. What do I do hear is a debate about which direction our path should take, and I think it’s instructive that Gawande treats universal health care via some combination of government programs as a given outcome at this point.
At the same time, Gawande is minimizing some of the challenges of our current system. He speaks briefly about cost, but this is a big problem that is itself fairly path-dependent. It’s a legacy that our future system will have to deal with, either by changes in how we finance health care or by deep changes in the practice of medicine – probably both. To the extent that elements of our current system prevents us to make those changes, we can’t simply build on those elements.
One last thing: I appreciate Gawande’s perspective on this, especially his charge that our system is guilty of “routine cruelty”. Lots of people know this as a matter of experience, but it’s reassuring to hear a physician acknowledge it.
