That is the dire prediction of Dr. Atul Gawande, a noted writer and surgeon who practices at Boston’s Brigham and Women’s Hospital and who Boston.com calls one of the most powerful and influential people in the medical community. This is the story he told at a recent speech as reported by the Boston Globe‘s Chelsea Conaboy on White Coat Notes at Boston.com:
My son was having trouble in school. He was doing fine but he had drifted down in his grades, and it just wasn’t getting noticed. He was in a class of 30 students to one teacher in the Newton public schools which is a well-funded district. And I went to the parent teacher conference with my wife to try to understand what we might be able to do to help with the situation.I ran into the new school superintendent, who had been hired to be a school reformer and help make the quality of our schools better. And I said to him, “What are you doing to work on this problem? We have 30 students in my son’s classroom. What are you working on these days?”And he said, “You know what I’m working on? You know what I spend more time on than anything else? Health care costs.” He said, “Our tax revenues have been flat. The school enrollment is up, and this year’s teacher health care premiums went up 9 percent.” I said, “Oh.” And I went off to the parent-teacher conference. (laughter)And on the way, I ran into a teacher that I had operated on. She’d had a lymphoma, and we’d been able to save her. But I realized she was one of that small percentage that accounted for more than half of their health care costs. And that’s when I realized, I had doomed my son’s education.Now, I do not believe that the choices are between whether my son gets a great education or his teacher gets great care for her lymphoma. I believe that it’s possible to have great care for her lymphoma and a great education for him. There’s nobody in Washington, that can calculate and devise a way to make that possible. Only people in health care can do that. Only the people here.
America’s great systems are in crisis today: health care, government, education and law. All of them are more expensive than they should be, none of them work particularly well (though there are pockets of real excellence everywhere), and whether we like it or not the United States will need more and better service from each of them as the 21st century rolls on.Nothing could be more urgent than our need to re-invent these basic institutions and systems that underpin modern life, and as Dr. Gawande’s example so dramatically shows, the systems are interrelated. Getting this right is going to take time, and is going to involve some painful adjustments for a lot of people. But there is no alternative — and the good news is that hard as it is for the United States to make these changes, we are better placed to begin than any of the world’s major countries. And the country that figures out and implements new and better ways of getting these vital services done will be the world’s economic leader in the decades to come.