The trouble with tribbles...

All bad precedents begin as justifiable measures.  -Julius Caesar

Desperate measures for desperate diseases   

So, as my co-author, Mike reminds me, I've been absent a looong time. Not without reason, mind you; it has been a tough year, and the clouds are only now beginning to clear. More on this later,( and in another post), but as both a provider and user of the health finance system (and as a beneficiary and victim in both roles, I might add), I have a pretty interested vantage on the healthcare reform ball-game.

So, today's post is about Atul Gawande's gate crashing, delivered suspiciously-on-schedule article, "The Cost Conundrum" which appeared in a recent issue of the New Yorker. You can find it here. Every word is true, (validated by my personal experiences), as far as it goes... 

If you are short on time or attention, link to the article, and skip what I am about to say. What he says is more interesting.

Yo may recall that Gawande, a general surgeon from the midwest, a physician child of physician parents, was a principal in the Clinton Healthcare reform braintrust as a young man. He subsequently completed a surgery residency, published a couple of books of New Yorker essays, and generally manages to nicely write stuff that is interesting to lay readers and medical professionals at the same time. (medical professionals might like his essay "On Washing Hands" which appeared in the NEJM. You can find it here.)

I don't want to critique "The Cost Conundrum" here; rather, I want to justify my post title. I have received links to this article now three times, excluding the one from my co-author, Mike, which was inexplicably lost in the ether (or my untamed gmail account...) That's incredible, exceeded only by solicitations to invest in Nigerian phishing schemes to move large sums money into my bank account, and the stupid morphed picture of the pig-nosed child with "swine flu." To use the term of art, the Gawande article has "gone viral," and will be a powerful influence in the coming reform battle and in Dr Gawande's role in that debate. (Oh, if you don't get the allusion in the title, go find the episode of star trek; it's worth it...)

So, finally and surely as Roosevelt exploited radio and Kennedy, TV, the Obama administration has mastered the web, not only as a tool of campaigning, but as a tool of legislating, which is a fish, as they say, of another garage (sorry). I am reminded as I write this, that much of what the Obama campaign did was based on foundation laid by a physician, Howard Dean, and he deserves an acknowledgement.

I muse, that the pace of technology being what it is, the current Iranian dissident movement is the first full-bore application of the next generation technological socio-political weapon; texting and twittering. I shall leave it to my betters to draw the obvious analogies between politics and war, and the role of new technologies in determining such contests. I will say that, where once I understood technological advance to be primarily physical (faster computers, more powerful weapons) I have come to a broader view which includes less tangible tools, i.e. ideas, logisitical advances, and the like. My more thoughtful colleagues will be saying "well dah," but after all, I was primarily an engineer.

I will not enter the fray on the merits of the current round of healthcare reform. But my initial quotations summarize my opposing feelings adequately, anyway.