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Scott Rosenberg

I'm glad to hear this. I'd read your piece last summer on "The Moral-Hazard Myth," so when I followed Kottke's link to this debate, I figured, "Gladwell's the one who'll be arguing for the Canadian system," and got thoroughly confused. Finally I checked the date on the piece and realized how old it was.


Not to veer too far off topic while not wanting to use my pathetic health insurance at the opthalmologist, but did you lose the battle with your dead tree publisher on using black paper with white ink and decide to take up that sword here?


I wondered how you felt now, six years later.


I'm find myself surprisingly glad to hear you say you've changed your mind on this matter. (Your last article in the New Yorker on this topic seemed so contrary to what was written in this article, I wasn't sure what was going on. Strange this very old article is getting a lot of play now.)


Funny you should mention that, Malcolm. I too found the resurrected link on one of the blogs I read, and was surprised at what you were saying.

Really excited to see you're blogging!


The Canadian system is all about preventative care, which enlists the agency of the individual, thereby semi-deflecting the moral hazard problem. If they want to stay healthy, they have to go to the doctor.

Mathew Ingram

It's interesting that the debate between you and Adam has suddenly turned up again -- I wasn't aware that it was that long ago until I came across this post. I guess you've been swatted by the "long tail" of the Web :-)


Thank you Malcolm. We're in for the battle of our lives. And I think the world is watching to see what will happen to what was once one of the finest social healthcare systems in the world. Whenever people ask my opinion on this issue I direct them to the great Tommy Douglas speech of 1979 (Douglas created our medicare system - for American readers):

"Don't let anybody tell you if we just went back to the free enterprise system. The old system of 'Every man for himself,' as the elephant said when he was dancing among the chickens. Let's go back to standing on our feet." - Tommy Douglas

Hear the speech via the link below. I think what Tommy says might resonate with Americans as well ...



A buddy of mine forwarded me the link yesterday, and him and I started arguing about it too. Turns out he agreed with a lot of the things that you said, whereas I agreed with Adam Gopnik. I can't tell you how satisfying it will be to let him know you now disagree with yourself. I think they call that a check mate :-)

Jonas Cord

Well, I'll be the contrarian here and say that it's rather unfortunate that Malcolm has completely changed his mind. Gopniks arguments seemed overly emotional and not particularily pragmatic (even if Malcolms arguments were a little too heavily of the devils advocate type).

If we all agree the problem is those who cannot afford health insurance, then clearly the answer is for the government to provide it. Why everyone should be provided care by the government isn't clear.


I recently read this article and was fascinated by it. It's interesting to hear now that you've changed your views but I'm glad to hear it. The best point I thought you made, however, went nearly undisputed by Gopniks which was the point that everyone else is "cherry picking" off the innovations stemming from the United States health care system. Do you still agree with that point that you made, today?


Now, if only Adam would get a blog, and we'd be set.


I'm relieved to hear that you've changed your position on healthcare. Six years have changed things quite a bit - at least in terms of American health care.


I had it posted to my blog as well and have just now updated it with your response. Thanks for posting about it. And welcome to the blogosphere.

Arnie McKinnis

that's the problem with taking a position (and then actually having it put into print) - it remains static, while our opinion may change overtime.

Robert Dean

I also recently read Blink. It was something I looked forward to reading after hearing you read excerpts on C-SPAN late one night.

I enjoyed the book, but I am so baffled how you have actually reversed your thinking on the whole idea of socialized medicine.

It shocks me that someone who had a potentially life-threatening injury, received very little treatment for it during the first week, and lived to tell the story, would now be saying that the Canadian system is better.

That truly fascinates me. I fail to see how widening the net of social control, and increasing the bureaucracy could possibly lead to better health care.

Shanti Braford

yes, I'd love to hear why you've changed your mind on the topic as well!

Dena Shunra

I think the question is always one of balance - and the balance in the U.S. healthcare system is skewed towards you-get-what-you-pay-for to an extent unacceptable to too many of the people the system serves and feeds on.

I'd say it would be interesting to watch how this resolves itself, but that may be a type of interesting usually mentioned in the context of abject horror and fear, which are just the sentiments aroused by being out of a job and with a sudden medical emergency. Will "Let them take aspirins" be the 21st century's response to Marie Antoinette's quip? I've heard quite violent sentiments from people involved in the system, both as doctors and patients. Interestingly, to overextend that word, they've tended to focus on pharmaceutical companies.


I think any country that would allow its citizens to die or go bankrupt because they can't afford basic health care serves the private, not public, good. And how many American citizens are able to afford the shoddy healthcare plans their employers offer (when they even offer them)? But what's really obscene is the people complaining the loudest about the "problems of public healthcare" are those who would never, ever require it themselves. If you had a truly democratic government you'd be spending some of your tax dollars on bettering society, not waging endless wars that achieve little more than benefitting arms manufacturers. Quality healthcare shoudl be a right, not a privilege.


I'd love to master extravagant, contrarian sensibility!

Troy Worman

Bourgeois sense or extravagant, contrarian sensibility. Hmmm. Tough call.


Mr. Gladwell, glad to hear you've started blogging, very cool. Not so happy to hear you changed your mind on healthcare, and I think it would be a nice gesture to your readers on why you've changed your mind.

Looking forward to reading your blog.



Nick Rowell

Malcolm, you've changed your mind? You would. You're contrarian!


Oh - this is lovely to find your blog.

The argument that innovation comes from higher-end care is, I believe, an assumption. I work within the American medical research community, an have trained at very highly-funded centers, and at smaller programs. It seems to me that innovation comes from innovative people solving problems when sufficient resources are available - not from money.

I think this is because innovations follow some of the same patterns of development as scientific discoveries. For all our attempts to target specific problems with directed research funding - solutions to a specific problem often arise from a more serendipitous journey.

At any rate, let me join the chorus - I am delighted that you are blogging. (Your most recent New Yorker article was part of my most recent post.) Cheers!


Hi. For those of us who are a bit unaware, could you please provide us a link to the transcript of the debate or perhaps a summary?


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  • I'm a writer for the New Yorker magazine, and the author of four books, "The Tipping Point: How Little Things Make a Big Difference", "Blink: The Power of Thinking Without Thinking" and "Outliers: The Story of Success." My latest book, "What the Dog Saw" is a compilation of stories published in The New Yorker. I was born in England, and raised in southwestern Ontario in Canada. Now I live in New York City.

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