Atul Gawande has the lead piece in the April 5th New Yorker, recounting the difficult birth of Medicare 45 years ago (among other things, it required hospitals to integrate!) and putting the new health care bill into perspective:

. . . Recently, clinicians at Children’s Hospital Boston adopted a more systematic approach for managing inner-city children who suffer severe asthma attacks, by introducing a bundle of preventive measures. Insurance would cover just one: prescribing an inhaler. The hospital agreed to pay for the rest, which included nurses who would visit parents after discharge and make sure that they had their child’s medicine, knew how to administer it, and had a follow-up appointment with a pediatrician; home inspections for mold and pests; and vacuum cleaners for families without one (which is cheaper than medication). After a year, the hospital readmission rate for these patients dropped by more than 80 percent, and costs plunged. But an empty hospital bed is a revenue loss, and asthma is Children’s Hospital’s leading source of admissions. Under the current system, this sensible program could threaten to bankrupt it. So far, neither the government nor the insurance companies have figured out a solution.

The most interesting, under-discussed, and potentially revolutionary aspect of the [new] law is that it doesn’t pretend to have the answers. Instead, through a new Center for Medicare and Medicaid Innovation, it offers to free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better care at lower costs. . . .

☞ The link to the full essay may not work for you if you don’t subscribe to the New Yorker. (You don’t subscribe to the New Yorker? What’s wrong with you?) But it builds on Dr. Gawande’s earlier brilliant piece, excerpted here, that recounted the enormous productivity gains realized in U.S. agricultural a century ago as a result of a government-sponsored scheme similar in some respects to this new health care approach.

It may be hard to convey all this in a sound bite. But passage of the health care bill is going to lead to more efficient, quality health care – a very big deal.


But you can’t watch this without wondering whether there shouldn’t be some way to get a lot of this bounty directly to food banks.


Scott Koppa: “Re: your recent link to the “Great Pacific Waste Patch” . . . a similar one was recently identified in the Atlantic. But on the bright side, a Canadian high-school student was able to isolate bacteria that metabolize plastic (he isolated them from a garbage dump…very bright boy). Now if we can just find a way to make that an economically viable proposition.”


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