Stop searching for the health reform silver bullet

Stop searching for the health reform silver bullet I recently had the privilege of joining the Yale Cancer Center’s contingent on a visit to University College London in the U.K., where we share a number of scientific collaborations.

Between discussions of pathways, particles, and personalized medicine, some of the “tea time” conversation turned to policy and how uninsured patients with cancer in the U.S. get care. We talked about quality, access, cost, and politics.  Surrounded by brilliant minds who were working diligently on figuring out the complexities of cancer where there are no simple answers, it became clear to me that there may be no simple answers to the health care debate as well.

It is, as Atul Gawande calls it in a recent article in the New Yorker, a “wicked problem … Wicked problems are messy, ill-defined, more complex than we fully grasp, and open to multiple interpretations based on one’s point of view.”

No sooner than I got back to the States, the Supreme Court ruling came out largely upholding the Affordable Care Act that, for the first time, has the potential to extend health care insurance to millions of currently uninsured Americans. Is it perfect? Of course not.

“No solution to a wicked problem is ever permanent or wholly satisfying, which leaves every solution open to easy polemical attack.”

Some argue that the Act goes too far, may cost too much, and may be too restrictive to individual liberties. Others argue that it doesn’t go far enough and still leaves people without coverage.

As I thought about our current system, a potential “Obamacare” system, the Canadian system with which I grew up, and the U.K. system that I had just visited, I realized that no system is “perfect” (if such a thing even exists). Perhaps, as one of my surgical mentors used to say, “perfection is the enemy of good.”

Rather than searching for an elusive silver bullet, maybe what we need (much like our work in cancer research) is constant progress in the right direction, or as Jim Collins would put it, concerted efforts to turn the flywheel. One thing is for certain, though.  If we do nothing, we implicitly either profess our system to be perfect or deny our ability to make any progress, and such arrogance or apathy would be perhaps the most tragic problem of all.

Anees Chagpar is an oncologist who blogs at ASCO Connection, where this article originally appeared.

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