Surely one of the finest analyses I have read regarding the problems associated with reforming our U.S. healthcare system. Atul Gawande's point--that in reforming our system we should build on what we have--is forcibly argued and makes perfect sense. My only reservation is that we might profit from the French experience (their healthcare system is widely acknowledged to be the best in the world), so it might be wise slowly to steer our healthcare behomoth in the French direction. Specifically, the French have constructed a firewall between the government and healthcare providers--all care is at the discretion of the providers, no prior approval required--which has made them the masters of billing efficiency. As Atul Gawande points out, cost reduction is a major weakness of existing patchwork systems.