Atul Gawande has an excellent short piece in the April 5 issue of the New Yorker magazine that details the fight that ensued in the wake of Medicare’s passage. It’s instructive, because it highlights that passing a health reform bill into law is not the end of the struggle, but merely the mark of a transition.
As Gawande outlines, there are a lot of similarities and a lot of differences between the passage of Medicare in 1965 and the passage of the Affordable Care Act in 2010. The ultimate deciding factor, he suggests, is how reform is actually implemented. If front line clinicians don’t do their part to help bring costs under control, the effort will likely be billed as a failure. On the other hand, if clinicians take some initiative, it is likely that this latest reform will become a success and in due course will be viewed through the rose colored glasses of history as Medicare is today.