Friday, December 18, 2009

Reducing healthcare costs

Atul Gawande has a great article in the New Yorker about how the Senate healthcare reform bill would reduce healthcare costs. Unlike expanding coverage, there's no simple solution to the cost problem, so the legislation authorizes dozens of "experiments" to find what works, just as was done a century ago when food costs were high in America and half of people worked in the agricultural sector:
There are, in human affairs, two kinds of problems: those which are amenable to a technical solution and those which are not. Universal health-care coverage belongs to the first category: you can pick one of several possible solutions, pass a bill, and (allowing for some tinkering around the edges) it will happen. Problems of the second kind, by contrast, are never solved, exactly; they are managed. Reforming the agricultural system so that it serves the country’s needs has been a process, involving millions of farmers pursuing their individual interests. This could not happen by fiat. There was no one-time fix. The same goes for reforming the health-care system so that it serves the country’s needs. No nation has escaped the cost problem: the expenditure curves have outpaced inflation around the world. Nobody has found a master switch that you can flip to make the problem go away. If we want to start solving it, we first need to recognize that there is no technical solution.

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