It’s what we’ve got

Path dependent policy is a reality and Atul Gawande writes in The New Yorker that health care reform must start with what we have:

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.

The Reverberations

Financial news writers have borrowed from the world of medicine in explaining last week’s financial fallout.  Turns out, the fallout from last week will likely have long-lasting health care policy implications, too.

An excerpt from The Health Care Blog: “the bailout will use up the fiscal margin for any subsidized solution to health reform. There will simply be no extra dollars in the federal budget for the uninsured for many years.”

Update: Here’s some more and why.