Someone else has heard of ‘path dependency’
January 29, 2009 Leave a comment
…And that someone writes for the New Yorker. Atul Gawande, a doctor who writes great articles about medicine and health care, takes up the U.S.’s prospects for a universal healthcare system by looking at the development of systems in the U.K., France, and Switzerland. He points out that none of these systems materialized overnight but rather sprung from smaller insurance programs that were already in place. The U.K. for instance had to ensure care for wounded civilians and returning soldiers during World War II, and the war forced the country to expand and improve services. So after such sweeping government involvement came the National Health Service in 1948, which is the system that fear-mongers tend to invoke when they speak of socialized medicine, even though nations like Switzerland and France have entirely different universal systems. (And even though we in the U.S. are not ones to talk).
What I was most excited about was that Gawande brought up a term “path dependency,” which was coined by social scientists, the folks who always have a term for the commonsensical doings of humanity. What is so intuitive about “path dependency” is that it is a way to describe instances when government social policy gets formed around already existing structures, like Britain’s NHS. So policies stem from already-existing groups, programs, and structures rather than being revolutions from above? Makes pretty good sense.
Myself and two fellow Northwestern students actually wrote an obscure paper on “path dependency” and relied a lot on the work of Paul Pierson which we did during our health policy studies semester in Paris in 2004. Pierson, who seems to do a lot of really good work–my snipe at social scientists aside– is mentioned by Gawande for his contribution to “path dependency” studies. I don’t want to suggest that my fellow students and I were anticipating this great piece by Gawande when we wrote this paper, especially because I basically concluded from it that it would take a disaster on the scale of World War II for the U.S. to institute universal healthcare. In fact, Gawande suggests that it could be a much more natural expansion of existing programs, like Medicaid, Medicare, and private, employer-sponsored health insurance–a Jerusalem-style building atop existing buildings. Also, he writes a much more readable and concise article than we did!