Reforming Health Care One Pilot Project at a Time

How is our medical care system like American agriculture before the era of modern food-growing practices? Pretty similar, argues Dr. Atul Gawande in the New Yorker. Both were expensive, wasteful of human resources and completely fragmented. And the cures for their problems could be similar too.

What reformed American farming and turned it into a world leader in producing low-cost food was the “extension” system that the government set up for teaching farmers, one county at a time, what worked and what didn’t work.

Dr. Gawande argues that the 2,000-page health care reform bill now in Congress has an optimistic prospect for using many pilot projects in funding health care to figure out what works to lower costs and increase safety and quality. It’s a fascinating argument, and I hope he is right.

I only differ from Gawande on one thing: he takes swipes at malpractice attorneys and the lawsuit system as contributing to the waste. That has not been borne out by careful studies. Moreover, patients need a robust system of advocacy for when preventable injuries have occurred. So far, no better system has been developed for getting to the bottom of what happened, to try to prevent it from happening again, and to give the patient fair compensation.

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