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• 13 Dec 09
  

  Bo Reid
• 15 Oct 09
  

  Aviva Gabriel

  In every industrialized nation, the movement to reform health care has begun with stories about cruelty. The Canadians had stories like the 1946 Toronto Globe and Mail report of a woman in labor who was refused help by three successive physicians, apparently because of her inability to pay. In Australia, a 1954 letter published in the Sydney Morning Herald sought help for a young woman who had lung disease. She couldn't afford to refill her oxygen tank, and had been forced to ration her intake "to a point where she is on the borderline of death." In Britain, George Bernard Shaw was at a London hospital visiting an eminent physician when an assistant came in to report that a sick man had arrived requesting treatment. "Is he worth it?" the physician asked. It was the normality of the question that shocked Shaw and prompted his scathing and influential 1906 play, "The Doctor's Dilemma." The British health system, he charged, was "a conspiracy to exploit popular credulity and human suffering."

  healthcare reform healthcare reform medicine economics atul gawande

• 18 Aug 09
  

  Jonathan Green
• 20 Jul 09
  

  Jason L

  health healthcare opinion history

  • It becomes more and more unlikely that you can simply shift from one path to another, even if you are locked in on a path that has a lower payoff than an alternate one.
  • early choices become difficult to reverse.
  • 6 more annotations...
  • • There had been little realistic consideration of how millions of elderly people with cognitive difficulties, chronic illness, or limited English would manage to select the right plan for themselves.
    • This is the trouble with the lure of the ideal. Over and over in the health-reform debate, one hears serious policy analysts say that the only genuine solution is to replace our health-care system (with a single-payer system, a free-market system, or whatever); anything else is a missed opportunity. But this is a siren song.
    • So accepting the path-dependent nature of our health-care system—recognizing that we had better build on what we’ve got—doesn’t mean that we have to curtail our ambitions. The overarching goal of health-care reform is to establish a system that has three basic attributes. It should leave no one uncovered—medical debt must disappear as a cause of personal bankruptcy in America. It should no longer be an economic catastrophe for employers. And it should hold doctors, nurses, hospitals, drug and device companies, and insurers collectively responsible for making care better, safer, and less costly.
    • we can construct a kind of lifeboat alongside it for those who have been left out or dumped out, a rescue program for people like Starla Darling.
    • The system will undoubtedly be messier than anything an idealist would devise. But the results would almost certainly be better.
    • For the past year, I haven’t had a single Massachusetts patient who has had to ask how much the necessary tests will cost; not one who has told me he needed to put off his cancer operation until he found a job that provided insurance coverage. And that’s a remarkable change: a glimpse of American health care without the routine cruelty.
• 01 Jul 09
  

  princesadechi
• 11 Jun 09
  

  T Cook

  health healthcare economics

• 07 Apr 09
  

  Jessica Reed

  Atul Gawande health care

• 26 Mar 09
  

  West Ed

  Every industrialized nation in the world except the United States has a national system that guarantees affordable health care for all its citizens. Nearly all have been popular and successful. But each has taken a drastically different form, and the reason has rarely been ideology. Rather, each country has built on its own history, however imperfect, unusual, and untidy.\nocial scientists have a name for this pattern of evolution based on past experience. They call it "path-dependence." In the battles between Betamax and VHS video recorders, Mac and P.C. computers, the QWERTY typewriter keyboard and alternative designs, they found that small, early events played a far more critical role in the market outcome than did the question of which design was better.

  theoryofchange adulted multpath context

• 06 Feb 09
  

  Tom Allen

  history of HC systems in Britain, France etc.

  opinion

• 03 Feb 09
  

  Todd Suomela

  Good history of Great Britain's transformation to national health care after WW2. Is rapid or gradual change more effective?

  health politics public-policy policy history economics gradualism

• 01 Feb 09
  

  moniwasweissich
• 30 Jan 09
  

  flyingkumquat
• 26 Jan 09
  

  siz nax

  #readme articles

• 20 Jan 09
  

  bjgcnm
• 19 Jan 09
  

  Geekgirl 397

  2009 healthcare newyorker obama economics health medicine insurance healthinsurance opinion gawande atulgawande toread nhs usa uk france socializedmedicine pathdependence

• 

  True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive.

  president_obama opinion healthcare reform insurance government war history europe england france massachusetts

  • With path-dependent processes, the outcome is unpredictable at the start. Small, often random events early in the process are “remembered,” continuing to have influence later. And, as you go along, the range of future possibilities gets narrower. It becomes more and more unlikely that you can simply shift from one path to another, even if you are locked in on a path that has a lower payoff than an alternate one.

    • 

      on 2009-01-19

      making a logical error here, or at best a weak argument. just because it happened incrementally for other nations in the past doesn't mean that's how it will or ought to happen here. Perhaps the incremental changes were the most those nations were capable of at that time, given resources, social awareness to change, available technology etc.
  • On January 1, 2006, the program went into effect nationwide. The result was chaos. There had been little realistic consideration of how millions of elderly people with cognitive difficulties, chronic illness, or limited English would manage to select the right plan for themselves. Even the savviest struggled to figure out how to navigate the choices: insurance companies offered 1,429 prescription-drug plans across the country. People arrived at their pharmacy only to discover that they needed an insurance card that hadn’t come, or that they hadn’t received pre-authorization for their drugs, or had switched to a plan that didn’t cover the drugs they took. Tens of thousands were unable to get their prescriptions filled, many for essential drugs like insulin, inhalers, and blood-pressure medications. The result was a public-health crisis in thirty-seven states, which had to provide emergency pharmacy payments for the frail. We will never know how many were harmed, but it is likely that the program killed people.

    • 

      on 2009-01-19

      This is a Republican plan, based on Republican ideology. Did anyone capable of seeing past this defunct ideology think it would work? THIS was incremental change as a result of pragmatism.
  • 1 more annotations...
  • • The Massachusetts plan didn’t do anything about medical costs, however, and, with layoffs accelerating, more people require subsidized care than the state predicted. Insurance premiums continue to rise here, just as they do elsewhere in the country. Many residents also complain that eight per cent of their income is too much to pay for health insurance

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