Friday, January 23, 2009

Getting There From Here

Dr. Atul Gawande has a thoughtful article in the New Yorker about the transformation of healthcare in other countries and how it might happen here in the US. He feels that Massachussetts' new law that requires everyone to get health insurance is a good but imperfect start:
For all that, the majority of state residents would not go back to the old system. I’m among them. For years, about one in ten of my patients—I specialize in cancer surgery—had no insurance. Even though I’d waive my fee, they struggled to pay for their tests, medications, and hospital stay.

I once took care of a nineteen-year-old college student who had maxed out her insurance coverage. She had a treatable but metastatic cancer. But neither she nor her parents could afford the radiation therapy that she required. I made calls to find state programs, charities—anything that could help her—to no avail. She put off the treatment for almost a year because she didn’t want to force her parents to take out a second mortgage on their home. But eventually they had to choose between their daughter and their life’s savings.

For the past year, I haven’t had a single Massachusetts patient who has had to ask how much the necessary tests will cost; not one who has told me he needed to put off his cancer operation until he found a job that provided insurance coverage. And that’s a remarkable change: a glimpse of American health care without the routine cruelty.

I also believe that healthcare reform will be evolutionary, not revolutionary, with many twists and turns, well-intentioned but misguided actions, quiet successes, loud opposition. But eventually we will get to where we are going, and when we get there, I hope that is where we will want to be.

Monday, January 19, 2009

I have a dream

I have a dream . . .

. . . that I can post regularly to my blog again.

In the meantime, here is what I wrote on the Ideal Medical Practices Blog, a new blog with contributions from others in the Ideal Medical Practice (IMP) Movement.