Thoughts from Atul Gawande on how to achieve universal coverage

In January, surgeon and well known author Atul Gawande contributed an article to The New Yorker sharing his thoughts on how the United States can achieve universal health care. The article, Getting There From Here, tries to take a pragmatic approach by comparing the US health care system to that of other countries. He focuses on countries whose systems had certain sets of problems (both moral and financial), and by modifying their existing systems to include everyone (in most cases by becoming mixed, private/government run systems), achieved universal coverage. While a seemingly moderate and practical approach, Gawande's article drew the ire of several doctors, leading health policy experts and single payer supporters. Single payer supporters, among other things, point out that building upon our existing system pays far to much deference to the for profit insurance industry and fails to account for the huge sums of money that are siphoned out of the system as profit. Central to Dr. Gawande's argument is the contention that it is essentially unfeasible for us to go from our current system to a single payer system overnight. He argues that the massive infrastructural and practical adjustment would be too catastrophic. This point also received some sharp criticism, correctly pointing out that countries like Canada have done this very thing Dr. Gawande sees as unfeasible.

In defense of Dr. Gawande I'm not entirely convinced his pragmatism is as insidious as some critics suggest. The reality is that the health insurance industry possesses great wealth and even greater lobbying power. It is perfectly feasible that one could look at such a juggernaut and come to the conclusion that it may be best to go around it rather than through it, not because it can't be defeated but because it may take years, even decades to do so, all the while the uninsured and under insured suffer. This also assumes that for profits have no place in health care which is far from a universally held belief.

Regardless of what you think, Getting There From Here along with it's critiques are worth reading, and even more importantly, worth thinking about.