Brother, I’m dying.

The wunderkind, Atul Gawande, writes about what’s wrong with America’s healthcare and how to fix it.  It’s in this week’s New Yorker.  He compares our system to other Western countries’–Britian, Canada, Switzerland (I believe), and France. 

Based on their paths toward universal coverage, he argues that we have to open up the various–and imperfect–government programs we already have to get everyone coverage.  That means opening up the VA system to non-vets, Medicare to people of all ages, and employer-based private coverage to the unemployed.

He attacks visionaries, on the left or right, who want to create a whole new system from scratch. Be pragamatic, he says, and work with what you got.  After all, other byzantine American systems have adapted just fine to monumental change: telephone lines went from analog to digital without tearing down posts.  Ditto for cable. Why not healthcare?

So, Gawande’s watchword is “pragmatism” (Obama!  You listenin’?!  Someone wants a job.) Build on what you got.

Also, read Marcia Angell’s hard-bitten piece from last month’s New York Review of Books.

It’s an overview of how doctors and pharmaceutical companies got us hooked on drugs.  Like Gawande, Angell’s a Harvard Med prof.  But unlike Gawande, who advised the Clinton admin, for better or worse, Angell was the editor of the New England Journal of Medicine. That matters.

Oh yes, and one more healthcare piece. It’s in this month’s Harper’s, and may curb Gawande’s enthusiasm. I haven’t read it, at least not yet, but with the title “Sick in the Head: Why America Won’t Get the Healthcare It Needs,” I’m assuming it’s not too cheery.

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