Enthoven Destroys Gawande

I have always kind of resented Alain Enthoven, although I'm not sure why. I think it's the air of infallibility he carries, not unlike the McNamara boys at DOD, which I think he was a part of, before he turned his attention to health care. Maybe it's because of his corporatism, and his sense that he uses the Palo Alto Medical Clinic and it's fine for him, so why shouldn't it be for everyone? I can give him several reasons why not - he is an insider, for one, so he's going to get care that's different, and just because he likes it.... Anyway, he is a cold fish. He doesn't have a humanitarian background. I'm such an independent guy that I just bridle at the thought of having to be contained in a corporation and to answer to corporate politicians. And he's at Stanford with their red shirts. Who knows?

But that doesn't obscure the fact that he is quite smart and often right. He is clearly one of the 5 top health care economists/policy experts. If we had adopted his Managed Competition proposals decades ago, American medicine would be in infinitely better shape than it is now.

And now I agree with him completely in his commentary on the insufficiency of the current health reform bills and their really pitiful proposals for pilot projects. Yucch!

Here is his commentary in the cloak of a response to the New Yorker article by Atul Gawande that assets the pilot projects might work in the way that the agricultural extensions worked a century ago in our rural areas. I love Gawande, but smart as he is, he's not a policy guy. Enthoven takes him apart.

http://healthaffairs.org/blog/2009/12/22/would-reform-bills-control-costs-a-response-to-atul-gawande/

Budd Shenkin