As might be expected, a piece in the New Yorker magazine describes health-care reform as “historic and necessary.” As might not be expected, the same article says that current plans do absolutely nothing to curb health-care costs in the US:

Cost is the spectre haunting health reform. For many decades, the great flaw in the American health-care system was its unconscionable gaps in coverage. Those gaps have widened to become graves—resulting in an estimated forty-five thousand premature deaths each year—and have forced more than a million people into bankruptcy. The emerging health-reform package has a master plan for this problem. By establishing insurance exchanges, mandates, and tax credits, it would guarantee that at least ninety-four per cent of Americans had decent medical coverage. This is historic, and it is necessary. But the legislation has no master plan for dealing with the problem of soaring medical costs. And this is a source of deep unease.


The article, written by Atul Gawande, who seems to have done something the senators haven’t (that would be read the bill), criticizes the proposals from the left:

So what does the reform package do about [expanding medical costs/] Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.


Gawande compares the health-care situation with that of agriculture before government got heavily involved in that sector. Some good ideas—that change should be piecemeal—and some I simply can’t evaluate. But the piece is full of ideas, and it’s the sort of discussion we should be having.