One of the primary criticisms I’ve seen leveled at the House and Senate health care reform bills is their sheer bulk. The fact that so many of our lawmakers admit to not having read the bills in their entirety, and the thousands of pages of obfuscated legalese have made the bills a popular target of both comedians and critics.
Atul Gawande, famous among health care reformers for his article last summer that became required reading among White House staffers, has written another noteworthy piece. He manages to make a five page article about health care reform both fascinating and informative, weaving together the story of the American agricultural revolution in the early 20th century with the current efforts to reform our health care system. He notes that there is no one solution to our health care troubles. There is no single way to cut costs, no quick fix that will provide access to affordable care for everyone. Instead, both the House and Senate bills contain numerous possibilities – in the form of pilot programs – that will test the waters and attempt to make improvements to our current systems. When we look back 20 years from now, we’ll be able to see which ideas worked and which did not. But until we test them, we won’t know.
Everyone involved in the health care system – health insurance companies, pharmaceutical and device manufacturers, doctors, and hospitals – will be asked to make changes under the health care reform bill. Some of the changes will no doubt end up lowering costs, and perhaps our health care delivery system will improve as dramatically as our agriculture system did a hundred years ago. David Harlow is encouraging doctors to keep an open mind and learn to work within new systems – and I would add that this approach will be helpful to all the other players in the health care industry too.
It’s easy to criticize the length of the health care reform bills (and I would agree that it would be more helpful if they were written in plain English), but perhaps they are so long simply because there is such a wealth of ideas contained within them. It will take the test of time to determine which of those ideas are true winners, but without including them in the language of the bills, we’ll never know.
The articles from Gawande and Harlow were both included in Grand Rounds this week.