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Observations Yankee Doodling

Our perfectly designed US healthcare system

BMJ 2008; 337 doi: (Published 24 November 2008) Cite this as: BMJ 2008;337:a2702
  1. Douglas Kamerow, chief scientist, RTI International, and associate editor, BMJ
  1. dkamerow{at}

    An interregnum thought experiment

    The interregnum between a presidential election and the inauguration is a time of feverish activity, in which the president elect and his staff decide who will help them govern and what they will try to do first. The press and pundits speculate breathlessly on who will be appointed and what they will do first. As I write this, for example, we have just learnt that the new administration’s secretary of health and human services is likely to be a respected former US senator, Tom Daschle. He has written a book about healthcare reform, which is likely to be his assignment when he starts in January.

    I’ve been musing about the United States and how perfectly designed our current healthcare system is. Perfectly designed, of course, as every system is, to achieve exactly the results it gets, as quality improvement guru Don Berwick famously said. In its own way, it is really rather remarkable. Here’s a thought experiment to illustrate what I mean.

    Suppose you have a big industrialised country that has lots of …

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