Tuesday, January 27, 2009

The Health Care You Have, Not The Health Care You Want

I believe in health care reform, but since I can't read or listen to more than 20 or so words at a time without thinking about food or wanting to take a nap*, it's hard for me to sink my teeth into, you know, learning anything about it. Fortunately for me, there exist magazines to cater to me and my tiny attention span.

The New Yorker came out this week with Atul Gawande's kind of sweet overview of how universal health care evolved in slavering backwards socialist nations like France, Switzerland and the UK. The thesis is pinned to path-dependence: there was never a traumatic overhaul with bureaucrats scrambling to radically change everything, rather, things just kind of happened. For example in the UK, WWII required massive government assistance to put health services out in the sticks, where everyone's kids were fleeing, and then when all that stuff got bombed they had to redo it. So by 1948 the NHS sort of already existed.

Many Americans envision universal health care as a change on the level of a Bolshevik revolution, and the author's idea is that it doesn't really have to be that way. No one is going to shut hospitals down for 5 days and raise your taxes to 50%. You build gradually on what you have, and the result is an imperfect but workable patchwork-quilt-style safety net.

I like the idea of making universal healthcare a palatable idea, which Gawande does in a very straightforward, non-wonky way. The problem he overlooks, I think, is that for these European countries, there was a serious impetus for these incremental changes like war (UK), famine (France), everyone else is doing it (Switzerland). Here, it seems that impetus does not exist, but for the Cries Of The People (and who ever listens to those anyway).

Well, actually, there is the obvious: that nearly 50 million of us have zero insurance, but that doesn't seem to have resonated with many of us. (I don't like thinking that we're so callous as to say that a Teddy Grahams heiress should be able to have lots of extra money lying around for Botox but not have to contribute jack to a laid-off factory worker's cancer treatment. But maybe small, incremental edits to our collective consciousness have created that culture.) It does seem that at a minimum, almost everyone agrees that more people need to have their basic needs cared for. So, a journey of a thousand miles, etc. But will there have to be a catalyst to, you know, take that first step? A catalyst besides the problem itself? I hope an administration that is supposedly built on pragmatic competence will find a way to get us somewhere without requiring it.

*Which makes being a) married to an academic and b) the sister of a health policy nerd AWESOMELY FUNNY. Them: "So basically this method of measuring the effect gives us new ways to control for these variables, and predict the..." Me: "Look, a butterfly."


Anonymous said...

So we need an impetus for health care reform? "Luckily" we have a gigantic economic crisis at hand. This crisis cannot be fixed without fixing health care. Spread the word.

E. said...

for real, an economic crisis and a health care crisis. let's see what else it's going to take.

Susan said...

I was always wondering what you were looking at over my shoulder while I was talking to you. It better have been a really REALLY pretty butterfly.

Mike3550 said...

Susan, I've just come to accept that look =) I find it endearing...

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