[Excerpt]
Moreover, we do have some excellent and outstanding prototypes of better care at less cost. Gawande and the President name them: the Mayo Clinic, Kaiser Permanente, Intermountain Healthcare, Geisinger, Scott and White, etc. So if they are so great, why haven't they proliferated and taken over America? —a question I have been hearing and answering for at least 30 years. --既然我们有一些出色的样本，连Oba毛主席都夸过他们，为什么他们没有在全美繁衍复制呢？
I wrote a paper called "Curing Fragmentation with Integrated Delivery Systems" for a June 2008 Harvard Law School conference, soon to appear in a book by Oxford Press. Briefly, in the first half of the 20th Century, the medical profession went all out to strangle these group practices with many reprehensible anti-competitive tactics. The Supreme Court found that organized medicine had violated the Sherman act when trying to destroy the Group Health Association. When Russell V. Lee founded the Palo Alto Clinic, the Santa Clara County Medical Society expelled him, and his expulsion had significant negative consequences for his malpractice insurance and hospital privileges. Organized medicine got laws passed to outlaw "the corporate practice of medicine". --历史啊，纠结
Then came World War II with the well known story of how exemption of health benefits from Wage and Price controls and income taxes put health insurance into employers' hands. And, for various reasons, most employers don't offer choices of health insurers, blocking competitive market entry by the health plans affiliated with medical groups. Or, if they do offer choices, employers like the state of Massachusetts pay 80-100% of the premium for the plan of the employee's choice, thus depriving efficient plans the opportunity to market their superior cost-effectiveness. On the other hand, a few employers like the University of California, Stanford — and, I believe, Harvard– as well as the states of Wisconson and California offer choices and a fixed dollar contribution so that efficient systems can reach the market and sell their superior cost-effectiveness. In these employment groups, large majorities usually choose efficient integrated delivery systems. That experience ought to be replicated across America. --选择、效率、竞争才有得追求（只有最好没有更好的社会肯定是奴隶社会）
As I listened to the President and read Gawande's citation of the iconic delivery systems, I thought "I wish they would ask themselves what it is about this health insurance market that prevents the Hondas and Toyotas of medical care from winning out." There is an answer. If America wants 1,000 pilot projects to blossom and grow into significant improvements in health care delivery, it must reform its system based on the principles of competition and wide, responsible, informed, individual consumer choice of health plans. Experience shows that people will join if they get to keep the savings. --人民的眼睛是雪亮的
Source: http://healthaffairs.org/blog/2009/12/22/would-reform-bills-control-costs-a-response-to-atul-gawande/
