Is Using a Checklist the Answer to All Your Problems?

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We will have fierce discussions three or four years from now as we learn what's working. If it turns out that for care of kids with asthma, teams that have salaried positions do better than the ones who have fee-for-service, we will have a national argument three or four years from now about whether we make all physicians begin making that transition.

Often in the past we've had pilot programs that showed us good things, and lobbyists killed them, but if we don't try, we're saying that we can't fix health care. Then we're doomed as an economy.

I don't think that's the way we are as a country. Despite the fierceness of the anger and arguments that have been swirling around, reform has kept moving forward. We're at the brink of a transformative change: an effort to actually solve a major problem.

TM:You're not saying we're on the brink of solving it, but just that we're on the brink of taking it seriously.

AG: For years we haven't had the guts to take on big problems. We haven't had the guts to take on environmental issues, we haven't had the guts to take on energy issues. If we kill this, it's saying we can't do it across the board. We can't even start.

TM: You worked in the Clinton White House when they were putting forward their healthcare reform plan. What do you think of Obama's methods? – not just with health care, but with financial regulation, climate and energy legislation. He outlines broad principles and then throws it to Congress, which ultimately means the Senate. I believe the Senate – and he knows this having been a senator – is the body most beholden to campaign funders.

Max Baucus, who gets only 13 percent of his funds from the State of Montana, 87 percent comes from people who have business with the finance committee; Kent Conrad, very similar situation; Joe Lieberman, from a state where insurance might be the largest industry….These guys end up having enormous power. Is that any way to arrive at the best solution?

AG: I'm not a campaign finance reform expert, but it's become clear to me that the power of the filibuster exacerbates the influence of money, giving the 41st senator unbelievable power. Scott Brown was elected in Massachusetts by saying he would be that 41st senator and could kill health reform.

There's something wrong when the representatives of less than 15 percent of the population have power to stop what the majority in the country want to achieve. California, similarly, struggles over the two-thirds vote in budget battles. Lobbyists then become very powerful, because you don't have to win the community, you just have to win one person.

TM: Finally, I know you listen to your iPod in surgery. What are you listening to these days, and what are you reading?

AG: Latest download probably Vampire Weekend's new album, which I really like. The band I think everybody should know about is Frightened Rabbit out of Scotland. Unbelievable. Their last album is called The Midnight Organ Fight . I love them and they get no attention. I'm reading Ludmilla Petrushevskaya's collection of macabre fables, There Once Lived a Woman Who Tried to Kill her Neighbor's Baby .