What’s so hard about health care reform?

[Fall 2013 Centennial issue]

Arnold Epstein“Change is usually slow. It moves in fits and starts and veers left and right. That’s how behavioral systems move. It’s true in every facet of our government: economic policy, foreign policy, transportation policy, education policy.

And proposals for policy reform are almost always heavily altered by lawmakers, because we live in an extraordinarily large society—300 million people, who don’t always agree on the proper role of government or on the tradeoffs implicit in various policies. I know of no instance when a policy reform idea went soup to nuts without modification.”

Arnold Epstein, Chair, Department of Health Policy and Management


Julio Frenk“The prospect of changing the health care system generates resistance because there are huge economic interests vested in the current structure: pharmaceutical, construction, equipment, information technology. It is the largest sector of the U.S. economy and 10 percent of the global economy. And health care is a major political issue.

Health systems also deal with the most vulnerable aspects of human existence: birth, death, suffering, uncertainty in the face of disease. They are our most sensitive point of contact with science and with formal institutions.”

Julio Frenk, Dean, Harvard School of Public Health


Atul Gawande“In the era of the iPhone, Facebook, and Twitter, we’ve become enamored of ideas that spread as effortlessly as ether. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.

But technology and incentive programs are not enough …. Every change requires effort, and the decision to make that effort is a social process. …

[H]uman interaction is the key force in overcoming resistance and speeding change.” (Excerpt from “Slow Ideas,” in The New Yorker, July 29, 2013)

Atul Gawande, Professor, Department of Health Policy and Management


Madeline Drexler