I was thoroughly affected by the recent article “Getting there from here,” in which Dr. Atul Gawande describes how we must build upon the healthcare systems we currently have here in the U.S. rather than try to blow up the model and create a brand new system. Gawande describes how universal care in the U.K., France and Switzerland all came to pass through pragmatic evolutions and their individual national, rather than “socialist ideology or a deliberate policy process in which all the theoretical options were weighed.”
In his blog entry, Mike mentioned path dependent evolution “where increasing returns are realized as more people organize their activities around earlier decisions.” This evolution will likely be key process to our own American healthcare reform. When it was originally created, our system’s outcome could never have been predicted and thus, we find ourselves now amidst a hodge-podge of systems – Veteran’s, Medicare, federal workers with private insurance (which, interestingly enough, Gawande parallels to the systems of the U.K., Canada, and Switzerland, respectively).
So now what do we do?
We can’t create a completely new system. As Gawande notes, “there is no dry-docking healthcare for a few months…while we rebuild it.” Too many people depend on it. And truth be known, no one knows enough, nor is influential enough to do so without a collapse of the entire American economy.
I see that over the course of the next half decade our system will continue its path dependent evolution. We’re likely stuck with an employer-based system for awhile. That’s not to say that change can’t occur, but a complete transformation of our healthcare system is likely to not. Gawande notes that throughout this reform debate, some people believe that the only solution is to completely replace our heathcare system (whether that’s with a single-payer, market-based, whatever). Like he says - and I agree - we have to build on what we’ve got. Else, we’re just missing the boat.