January 29, 2009 8:01AM 

# Atul Gawande Is Right 

By [Michael F. Cannon](https://www.cato.org/people/michael-f-cannon) 

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[Path dependence](http://en.wikipedia.org/wiki/Path_dependence) plays a huge role in [shaping nations’ health care sectors](http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande?currentPage=all). Path dependence is also why we want health care reform to nudge America toward freer markets.

[Government exacerbates path dependence](http://www.catostore.org/index.asp?fa=ProductDetails&pid=1441301). Government gives the old order the power to block the new. The larger the role government plays in health care (or anything else), the harder it is to make incremental changes that would yield greater benefits than existing arrangements.

That’s why, as Gawande observes, [Medicare](http://www.catostore.org/index.asp?fa=ProductDetails&pid=1441322) [does a lousy job](http://article.nationalreview.com/?q=ZjA0NTk1MmNhNDEzNzk0YjIyMGQ3Y2I2MTE5OGM2Y2Y=) of improving quality. ([Or containing costs](http://www.cbo.gov/ftpdocs/88xx/doc8877/Frontmatter.1.3.shtml), for that matter.) Medicare and [other](https://www.cato.org/pub_display.php?pub_id=9640) government [interventions](https://www.cato.org/pub_display.php?pub_id=9878) are also why we don’t see enough innovation in the private sector, either.

So if you want tomorrow’s health care sector to have the same problems with cost, quality, and access as today’s, then by all means expand [Medicare](https://www.cato.org/pub_display.php?pub_id=6324). Or create a government-run “[exchange](https://www.cato.org/pub_display.php?pub_id=6407)” like the Federal Employees Health Benefits Program. Or expand the [Veterans’ Health Administration](https://www.cato.org/pub_display.php?pub_id=8140). Or expand [Medicaid](https://www.cato.org/pub_display.php?pub_id=4049) and [SCHIP](https://www.cato.org/pub_display.php?pub_id=8697).

But if you’d rather a health care sector that constantly makes improvements in cost and [quality](https://www.cato.org/pub_display.php?pub_id=9878), you need to let [seniors](http://www.catostore.org/index.asp?fa=ProductDetails&pid=1441322) and [non-seniors](http://www.bepress.com/fhep/11/2/3/) alike control their health care dollars and choose their own health plan.

##### Related Tags 

[General](https://www.cato.org/general), [Health Care](https://www.cato.org/health-care) 

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