From his commencement address at Harvard Medical School:

The distance medicine has travelled in the couple of generations since is almost unfathomable for us today. We now have treatments for nearly all of the tens of thousand of diagnoses and conditions that afflict human beings. We have more than six thousand drugs and four thousand medical and surgical procedures, and you, the clinicians graduating today, will be legally permitted to provide them. Such capabilities cannot guarantee everyone a long and healthy life, but they can make it possible for most.

People worldwide want and deserve the benefits of your capabilities. Many fear they will be denied them, however, whether because of cost, availability, or incompetence of caregivers. We are now witnessing a global societal struggle to assure universal delivery of our know-how. We in medicine, however, have been slow to grasp why this is such a struggle, or how the volume of discovery has changed our work and responsibilities.

Gawande is optimistic that changes in how we deliver healthcare can help to hold down costs (and more importantly, reduce errors, bad outcomes and deaths).

The question, I think, is whether those changes can be driven by policy rather than by care providers themselves — particularly when policy is required to deliver “results” on the short time-horizons that we demand (i.e. preferably two years before the next election).

But the first challenge is getting politicians and public servants to understand that the levers they have immediately to hand — funding, salary negotiations, regulation — are pretty much irrelevant to creating effective clinical teams.