Atul Gawande, MD, The Health Reform Grandee

A grandee, according to my dictionary, is somebody with the power to persuade somebody highly influential and respected, especially a politician.

Atul Gawande fits that description. As a 47 year old general surgeon at Brigham and Women’s in Boston, an associate professor at the Harvard School of Public Health, a member of the faculty at Harvard Medical School, former Rhodes Scholar, adviser to Hillary Clinton’s 1994 health care task force, staff writer for the New Yorker and Slate, and author of bestsellers as Complications and Checklist, he has all the credentials to be influential with Democratic politicians.

After reading one of Gawande’s New Yorker essays, “The Cost Conundrum,” a blistering attack on alleged profiteering by doctors in McAllen, Texas, President Obama showed the article to a group of senators including and said, "This is what we’ve got to fix.”

Not only is Gawande an influential doctor with solid Democratic and Harvard think tank credentials, he is one hell of a writer.

Bob Wachter, MD, a prominent West Coast medical academic, says Gawande has mastered the techniques that “make his writing lyrical and memorable.”

These techniques include:

1) Making his first sentence count.

2) Using everyday language.

3) Telling stories rather than reciting data.

4) Relating inconvenient truths.

5) Showing humility.

6) Taking the high road.

Wachter omitted two salient truths.

One, as an elitist Democrat, policy wonk, a Boston-based surgeon, and political adviser, Gawande knows exactly where he is coming from.

Two, Gawande, he knows his readers, who read his material in the New Yorker, Slate, and Op-Ed pieces in the New York Times and Washington Post, will agree with his views.

A good example is his current essay in the New Yorker, “Now What?” It anticipates the line of attack health reform critics will take. He starts with a historical review of what Medicare critics took to undermine that program. He says LBJ, the master political strategist, out maneuvered his opponents.

He says President Obama can expect party politics to intervene with implementation. They will try to repeal the new law. They will criticize individual and business mandates. They will complain about the massive bureaucracy and administrative difficulties of state run health exchanges. Above all, they will cite “unaffordable costs” of health reform.

Gawande believes some down-home innovations, such as inspecting the homes of asthmatic children for molds and pests and providing their families with free vacuum cleaners, will solve some cost problems by decreasing hospital re-admissions, and top-down innovations, such as those developed by the Center of Innovation for Medicare and Medicaid, which are part and parcel of the new law, will decrease costs.

Gawande claims Obamacare is not “a government takeover.” Instead it depends on local communities and clinicians to do what needs to be done. The battle for health reform, whether it survives or flounders, he concludes, “has only begun.”

Gawande is right. The battle has just begun. And as I point out in my last two blogs predicting the reform situation in 2015, health reform opponents may have the upper hand because of Democrat political reverses and unanticipated adverse consequences of the new law.