The Idea Blog

Atul Gawande in the July 23 issue of The New Yorker lays out a dimension of the complexity inherent to any consideration of healthcare reform.

“The cheapest proposals circulating would still require more than a hundred million dollars a year in public funds - around a  thousand dollars per American household. Taxing millionaires or cutting ‘waste, fraud, and abuse’ won’t pay for that. Then we get bogged down in the innumerable, wearying complexities: whether abortions will be covered, whether states will be allowed to design their own systems, what’s an acceptable co-payment for drugs - and on and on. Finally Americans are deeply skeptical about government, and it doesn’t take much to sow doubts about expanding its role.”

In other words - and I fear this too - when major, serious reform reaches legislative debate, it will be so complex, so fractured by this motive and that need, this shibboleth and that sacred cow, this initiative to instill and encourage innovation and that fear of cost and control, the whole thing, its size and scope more daunting than that of any other issue - the whole thing will spin out of control, and we’ll be left only with the temptation to do nothing.

“So if, in the throes of the debate, you find yourself experiencing blurred vision, headache, and vertigo, here’s a prescription: go visit an emergency room, clotted with the uninsured, and see what it’s like to try to get care. Or watch [Michael Moore's 'Sicko']. Either way, you’ll be outraged again.”

And maybe we’ll do something worthwhile.