Gladwell's tipping point.

You may recall that in 2000, this magazine published a debate on the Canadian health system between Adam Gopnik and Malcolm Gladwell. The reason I asked the two to debate was that I had learned that Gopnik was the author of an anonymous but very persuasive item in favor of the Canadian system published in The New Yorker's "Talk of the Town" section. Earlier, I had, over a lunch with Malcolm Gladwell, found that he made the most effective case I'd heard against the Canadian system.

Six years later, in a New Yorker article rifled "The Risk Pool," Gladwell implied that he now found himself in favor of the Canadian system. I wrote asking if my inference was correct. His reply was affirmative:

"Why have I changed my mind?.... I woke up one day and realized what much smarter people than me (Adam Gopnik) realized a long tune ago, which is that the idea of employer-based health care is just plain stupid--and only our familiarity with it and sheer inertia prevent us from rising up in rebellion. I always try to think of a suitable analogy and fail. The closest I can come to is, imagine if we had employer-based subways in New York. You could ride the subway if you had a job. But if you lost your job, you would either have to walk or pay a prohibitively expensive subway surcharge. Of course if you lost your job you would need the subway more than ever because you couldn't afford taxis, and you would need to travel around looking for work."

Gladwell went on to say that the mistake he made in the Monthly debate was, "I confused a funding problem with a systemic problem.... On a per-capita basis, Canadians now spend on health care something like 60 percent of what Americans spend. If that were increased to say, 65 percent, many of the rationing and wait-time problems would be alleviated. The problem with American health care, by contrast, is systemic. No simple increase in funding fixes the problem."