Gawande likens the state of health care to farming at the beginning of this century and what’s happened since. Individual doctors, patients and communities must make their own decisions, and work constantly to innovate, share knowledge, and solve the problems they have, alongside government officials (but not top-down mandates).
“At this point, we can’t afford any illusions: the system won’t fix itself, and there’s no piece of legislation that will have all the answers, either. The task will require dedicated and talented people in government agencies and in communities who recognize that the country’s future depends on their sidestepping the ideological battles, encouraging local change, and following the results. But if we’re willing to accept an arduous, messy, and continuous process we can come to grips with a problem even of this immensity. We’ve done it before.”
Like NOAA maybe? It’s a fine line to walk and maybe we can do it.
Anyways, a libertarian friend makes the argument that while this would be nice if it worked, it’s simply more of the same: extending health-care to is akin to extending home-ownership to all (Fannie Mae and Freddie Mac)…or college education to all. That’s too much egalitarianism, and look for the political and social consequences.
I don’t think she’s winning the argument right now…