Health Care Reform as a Journey, not a Destination
on December 07, 2009 at 04:56 PM EDT
Atul Gawande — surgeon and journalist — once again writes a trenchant article
examining a key question about health reform: in particular, how can we improve care and reduce costs? Gawande’s answer: there is no single, right answer.
What is needed, instead, is a process of continuous improvement in health care. After all, comprehensive health reform has never been done before, so we can’t have 100 percent certainty about precisely what will work and what won’t. And because health care is such a dynamic sector, even if we had "the" answer for right now, the right mix of reforms would have to evolve in the future.
What we do know — and what is reflected in the reform bills under consideration — is that health analysts generally agree on the types of delivery system reforms that hold the most promise, even though less agreement exists on exactly how to configure these changes. In the bills, many of these ideas are therefore (appropriately) implemented through pilot programs that can be scaled up once we see what works. With the addition of investments in health IT, research into what works and what doesn’t, and a Medicare Commission of medical experts that can make recommendations to improve the system, we will be creating a continuous feedback process in which more information is available, different delivery system reforms are tested, and we have an ability to go to scale quickly as we learn more.
All together, I agree with Gawande about the health reform legislation, that "in the end, it contains a test of almost every approach that leading health-care experts have suggested" — and that’s a good thing, since reform is a journey, not a destination. It’s an ongoing process. For that very reason, we need to get that process started now.