Our broken health care system, should we start all over from scratch?

If you’re a staunch single payer supporter or a free market advocate, you’re likely going to be disappointed with how health reform is going to play out.

In an excellent piece, Atul Gawande discusses the history of health reform (via Ezra Klein) in other countries that have universal care, like Canada, the UK, France and Switzerland, and how those systems came to be.

Completely scrapping our health care system to implement the ideal of the left or right is simply not feasible, as Dr. Gawande points out that “the system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die.”

He notes that we already have three established systems in this country of varying effectiveness, the VA, Medicare, and the private insurers. Predictably, there is an inverse correlation between patients’ freedom of choice and cost control, with the VA controlling costs and restricting choice the most, and private insurers, the least. Medicare falls somewhere in between.

A pragmatic approach is needed to bridge the differences between the left and right, hospitals and economists, physicians and health policy wonks. Doing so means supporting the center and building upon what we already have, leaving those who advocate on either extreme increasingly irrelevant in the health care reform debate going forward.

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