As the Senate struggled through its work to find sixty votes on healthcare reform, I noticed something very interesting in the health reform articles. (Articles don’t just stand on their own but form a web of conversation.) There is a robust dialogue in the spheres of academia, think tanks, literary magazines, blogs and some newspapers. I would like to share that conversation with you, if like many Americans, you don’t have time to read the Atlantic Monthly, New Yorker or Wall Street Journal cover to cover.

Here is some of December’s key dialogue which seemed to me less influenced by political leaders, who were buried away behind closed doors.

In my first post on Healthcare Letter to Americans, I quoted an important article written by Dr. Atul Gawande in the New Yorker comparing the staggering differences in costs of healthcare in two comparable Texas towns. Even President Obama referred to this oft-cited article. Dr. Gawande espoused that meaningful change had to come from within the industry. “Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can.”  My sense was he saw the current reform process missing the bigger picture.

Jump four months forward, and my ever-faithful mother sent me (yes – I share the trade secrets of a blogger) an article written by the same author in the December 14 New Yorker.  Titled, “Testing, Testing,” this latest article took a different bent. It compared the current Senate reform full of pilots, incentives and other regulatory pushes with the government intervention in our agricultural industry in the early twentieth century and ensuing successful outcomes. To quote Dr. Gawande at the end of the article, “But if we’re willing to accept an arduous, messy and continuous process, we can come to grips with a problem even of this immensity. We’ve done it before.” Most importantly though Dr. Gawande was taking the stand that what we have now in the Senate was worth pursuing, meaning, let’s get on board here folks.

No sooner than the ink had dried but the Wall Street Journal wrote an editorial, “The ‘Cost Control’ Bill of Goods,” citing the growing number of people who had abandoned the idea that reform would reduce costs but were looking for other reasons to support the bills. It highlighted the Leonhardt article in the New York Times (posted here in November), the just-printed Gawande article, as well as others. The WSJ editorial board summed up by saying, “They might have piped up earlier: What they’re finally admitting is that all the grandiose talk about “bending the cost curve” used for months to sell ObamaCare really comes down to their hope that bureaucratic improvisation will make a difference over the long term.”

Perhaps more interesting, on December 22, in an article written for Health Affairs, The Policy Journal of the Health Sphere, Professor Alain Enthoven wrote a very structured argument identifying three flaws in Dr. Gawande’s position and positing that the current reform is an economic recipe for disaster. He also advocated ideas for reducing costs that he has been espousing for several decades.

In his opening paragraph, Prof. Enthoven intertwines policy and politics by writing, “Atul Gawande, MD, is one of the best medical writers of our time. I subscribed to the New Yorker just so I could read him. I reached eagerly for my December 14, 2009 New Yorker when I read he had an article there. I was deeply disappointed. What worries me is that his article will be used to support a political campaign to gloss over the failure of proposed legislation to significantly moderate health expenditure growth.”

When I finished this article and got a moment between holiday preparations to reflect, I had a satisfying moment of feeling included in the conversation.

As a Christmas present to yourself, please take a break this Holiday Season and sit at the table with Dr. Gawande, Professor Enthoven and others. Join in a fascinating and necessary conversation.

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