Health Center Federal Policy

A Prescient Voice from the Past

By John Sawyer

atulheadshot_001One of the more influential public voices in this year’s health reform debate is New Yorker magazine correspondent (and Boston surgeon, and former Clinton administration staffer) Atul Gawande.  His piece, “The Cost Conundrum”, has been required reading in policy circles in DC for months.

But it’s an older piece by Gawande that keeps entering my head these days.  Back in 2007, in a discussion of the Michael Moore documentary “Sicko“, Gawande looked into his health reform crystal ball and sketched out a remarkably prescient scenario for 2009:

If, in 2009, we actually swear in a President committed to universal health care, the fight will turn ugly. The plan most likely to gather broad support will look something like the Edwards/Obama approach, which would subsidize health insurance for everyone who does not receive coverage through work or through existing programs. It would provide a choice of private insurance options, as in the Netherlands, and would probably add a Medicare-like government option as well. And it would require Americans to obtain coverage for, at a minimum, their children.

People on the right will attack the plan as a tax-and-spend nightmare, because it will have to include some mixture of increases in business and personal-income taxes. And they’ll say that it dictates your medical choices and gives government too much control. People on the left—Moore included—will attack the plan as a boondoggle for insurance companies, because it isn’t single-payer, and will say that it gives government too little control. Others will attack it for what it does or doesn’t do about malpractice litigation, birth control, acupuncture, and so forth. The debate will become angry and murky and mind-numbingly complicated, and the temptation will be to put off reform yet again.

That’s exactly when you’ll need to remind yourself of what’s really at stake. So if, in the throes of the debate, you find yourself experiencing blurred vision, headache, and vertigo, here’s a prescription: go visit an emergency room, clotted with the uninsured, and see what’s it like to try to get care. Or watch the movie. Either way, you’ll be outraged again.


  1. I totally agree- this country desperately needs reform. I work in a community health center and the ER. Know exactly you are talking about. I also believe that the way we can fund this reform is if everyone who does work pay a percentage based on income towards health care. We are all in it and we all stand to benefit from it- nothing is for free! Josie Di Cesare

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