“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.”

In this eloquent piece in the New Yorker, Atul Gawande, who I just blogged about a day ago, argues that successful health care reforms build upon what already exists. While many would call these types of reforms “incremental” or “piecemeal”, Gawande argues that it does not mean that these types of reforms necessarily need to be unambitious.

“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.”

On the eve of President Obama’s inauguration, I don’t think this article could have been better timed – or better argued. The health insurance systems in place in Canada, the UK, France, and Switzerland were all responses to the second world war. The individual circumstances of each country during the war – evacuation of London, Americans fighting overseas, Swiss neutrality – to some extent explains the systems now in place in each country. Could the current economic crisis be enough to spur such reforms here in the US?

“Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have.”

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