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Considering how f...ed up the American health system is on all levels I am fine with giving an outsider a chance. Gawande appears to be a reasonable guy and a g

Considering how f...ed up the American health system is on all levels I am fine with giving an outsider a chance. Gawande appears to be a reasonable guy and a good communicator. Even if he fails, nothing is lost because the system can't get worse.

jonlucc 8y ago
This is exactly the same logic I heard used by many people voting for Trump. The truth is that there usually is a real downside from failure, even if it feels like our huge systems are as bad as they can get. In other words, while we do have an expensive system with worse outcomes than peer nations, at least right now we have healthcare being delivered at a first-world level, and we shouldn't take that for granted.
- where_do_i_live 8y ago
  Well... uhh... this guy is not in charge of everyone's healthcare - he's in charge of a rather small group of companies instead. The consequences of failure here are not exactly analogous to your example. 330 million people are not going to impacted by whatever is considered a failure here.
  - jonlucc 8y ago
    For now, but if I remember correctly, the goal is for these companies to offer this as their employees' health plans before expanding more broadly. For those people (and there are somewhere around a million customers between the companies), this could be worse than not being offered insurance.
    - adventured 8y ago
      They have no publicly stated goal to expand more broadly. That's nothing more than media speculation and or wishful thinking. Buffett has repeatedly said this is not an entity that is meant to offer services beyond the scope of the three companies or similar. They plan to share what they learn, and Buffett has said he hopes that can help other companies and the wider healthcare system. Here's probably the best talk he has given on the subject (13 minutes long, from a few months ago): https://www.youtube.com/watch?v=F4fuVC6zCJI https://www.youtube.com/watch?v=F4fuVC6zCJI
  - achow 8y ago
    Exactly. The three companies [Amazon, JPMorgan, and Berkshire Hathaway] are self-insured employers, which means that when you're an employee going to a doctor's appointment, your employer, rather than a health insurer, is ultimately footing the bill for the MRI exam you receive... "We're already the insurance company, we're already making these decisions, and we simply want do a better job," - JPMorgan CEO Jamie Dimon http://www.businessinsider.com/amazon-jpmorgan-and-berkshire-hathaway-health-joint-venture-ceo-pick-2018-6 http://www.businessinsider.com/amazon-jpmorgan-and-berkshire... Surely, that should be manageable for an insider like Atul Gawande. And it is nowhere same as wrangling with legacy American healthcare system (where one is dealing with insurance companies among others).
- trevormorgan 8y ago
  I see HN is still coping with Trump as President.
- maxxxxx 8y ago
  He will.be in charge of a relatively small company that still has very vague goals. He won't be running Medicare. If we are afraid of experiments on even the smallest scale there will never be any improvement.
- EpicEng 8y ago
  Comparing the presidency to this CEO position is just silly.
- pwinnski 8y ago
  The "outsider" in this case is still a surgeon, and teaches at Harvard. I don't think the comparison is apt.
nappy-doo 8y ago
Ah, the ol' MAGA argument.
- maxxxxx 8y ago
  I have never heard anything from Gawande that made me question his judgement. Whereas I have heard a lot from the MAGA guy that made me question his.
- kcommam 8y ago
  This would actually seem to be the misunderstand antecedent to the MAGA argument, which uses successful examples of exactly this type of "disruption" to fallacious claim replacing governance experience with business experience will have positive results.

jonlucc 8y ago

This is exactly the same logic I heard used by many people voting for Trump. The truth is that there usually is a real downside from failure, even if it feels like our huge systems are as bad as they can get. In other words, while we do have an expensive system with worse outcomes than peer nations, at least right now we have healthcare being delivered at a first-world level, and we shouldn't take that for granted.

where_do_i_live 8y ago
Well... uhh... this guy is not in charge of everyone's healthcare - he's in charge of a rather small group of companies instead. The consequences of failure here are not exactly analogous to your example. 330 million people are not going to impacted by whatever is considered a failure here.
- jonlucc 8y ago
  For now, but if I remember correctly, the goal is for these companies to offer this as their employees' health plans before expanding more broadly. For those people (and there are somewhere around a million customers between the companies), this could be worse than not being offered insurance.
  - adventured 8y ago
    They have no publicly stated goal to expand more broadly. That's nothing more than media speculation and or wishful thinking. Buffett has repeatedly said this is not an entity that is meant to offer services beyond the scope of the three companies or similar. They plan to share what they learn, and Buffett has said he hopes that can help other companies and the wider healthcare system. Here's probably the best talk he has given on the subject (13 minutes long, from a few months ago): https://www.youtube.com/watch?v=F4fuVC6zCJI https://www.youtube.com/watch?v=F4fuVC6zCJI
- achow 8y ago
  Exactly. The three companies [Amazon, JPMorgan, and Berkshire Hathaway] are self-insured employers, which means that when you're an employee going to a doctor's appointment, your employer, rather than a health insurer, is ultimately footing the bill for the MRI exam you receive... "We're already the insurance company, we're already making these decisions, and we simply want do a better job," - JPMorgan CEO Jamie Dimon http://www.businessinsider.com/amazon-jpmorgan-and-berkshire-hathaway-health-joint-venture-ceo-pick-2018-6 http://www.businessinsider.com/amazon-jpmorgan-and-berkshire... Surely, that should be manageable for an insider like Atul Gawande. And it is nowhere same as wrangling with legacy American healthcare system (where one is dealing with insurance companies among others).
trevormorgan 8y ago
I see HN is still coping with Trump as President.
maxxxxx 8y ago
He will.be in charge of a relatively small company that still has very vague goals. He won't be running Medicare. If we are afraid of experiments on even the smallest scale there will never be any improvement.
EpicEng 8y ago
Comparing the presidency to this CEO position is just silly.
pwinnski 8y ago
The "outsider" in this case is still a surgeon, and teaches at Harvard. I don't think the comparison is apt.

nappy-doo 8y ago

Ah, the ol' MAGA argument.

maxxxxx 8y ago
I have never heard anything from Gawande that made me question his judgement. Whereas I have heard a lot from the MAGA guy that made me question his.
kcommam 8y ago
This would actually seem to be the misunderstand antecedent to the MAGA argument, which uses successful examples of exactly this type of "disruption" to fallacious claim replacing governance experience with business experience will have positive results.