Atul Gawande: The Road Ahead

From The New Yorker:

ScreenHunter_02 Sep. 10 11.19 Before President Obama’s speech on health care, I wrote out a list of what I thought we needed him to do.

  1. Make clear the stakes.
  2. Make clear what we get under his reform.
  3. Understand our fears.
  4. Convey strength in the face of them.
  5. Speak to our core beliefs as a nation.

I thought he did this and did it amply. He made clear that our present system is damaging our people and damaging our economy. He made clear that if we accepted the challenge and the struggle, we could have better insurance coverage without preëxisting condition exclusions or sudden disappearance of benefits. Those of us who are self-employed or unable to get coverage through work could have the kinds of insurance choices and discounts that big companies and congressmen can get. Those who don’t have the money for this coverage could get tax credits to offset the costs. The elderly would get a better drug-benefit package.

There was nothing here that was watered down or unfamiliar, either. He did not skirt the realities that this would have to be paid for—that government would be requiring many businesses to cover their employees and most individuals to carry insurance coverage, and that he would be using money from ending subsidies to Medicare HMOs to help finance the bill. And he spoke with podium-pounding conviction in response to the absurd charges that this would involve government takeover of our doctor’s offices and to the deeper fears that those charges fed into.

After far too many weeks, he again became the Barack Obama one could rally behind—the cool-headed president willing to face long odds and enemy fire, rather than the coolly calculating professor with the academic’s annoying certitude.

As I said, he checked all the boxes on my list. And yet I remain concerned that he may not have done enough.

More here.