Another "must read" on health care

This week's New Yorker publishes another in a series of exceptional health care reform pieces by Atul Gawande. This week he writes about the way forward, as embodied in some lesser-known provisions in the House and Senate bills now making their way through the process. More precisely, he writes about the ways forward---namely, that effective solutions to the crisis (and he is chillingly specific about the magnitude of the financial catastrophe that awaits us if we do nothing) are less likely to emerge from top-down government-sponsored programs and regulations and more likely to result from local initiatives at the city, county, and state levels.

He uses the history of agricultural reform in the US in the early 20th century to make the case for how change can bubble up from below, through trial and error and expertise developed at the local level that is then shared and adopted---gradually at first--by other practitioners. And results can then quickly be disseminated through information systems and technologies we now possess that are hundreds of times more efficient than 100 years ago.

Fascinating reading, which you can find here http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande if you don't want to go out and purchase the Dec 14 issue.