Incremental change

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How Everyday Products Make People Sick: Toxins at Home and in the Workplace Paul D. Blanc, M.D. See book keywords and concepts

The initial incremental change in this direction occurred when artisans, using very simple materials, first figured out how to adapt the insoluble plant resins for other purposes, paving the way for a technological revolution in glue making that would eventually follow this same path. On the face of it, the insolubility that resins display seems to go against the fundamental living requirement of water compatibility. If vegetable gum and animal collagen both have to play by these rules, why not resins? And if plant resins are so sticky, how is it that sap flows so well?

Appetite for Profit: How the Food Industry Undermines Our Health and How to Fight Back Michele Simon See book keywords and concepts

Perhaps incremental change is the most viable strategy. But what if we shifted the conversation entirely? Instead of asking how schools can still make money by selling children slightly healthier food and beverages provided by corporations, how about we figure out how to serve healthy school meals and provide locally grown fresh fruit as snacks? Many advocates are also working hard to improve school meals, for example, through innovative "farm-to-school" programs. We need to tie these efforts into larger conversations about corporate marketing in schools.

Health Care Meltdown: Confronting The Myths and Fixing Our Failing System Bob LeBow, M.D., M.P.H. See book keywords and concepts

We are seeing a variety of efforts toward incremental change today. Some, like myself, who advocate for comprehensive change, nonetheless pursue some of the incremental efforts du jour, such as follow-up care for women who are found to have breast cancer, because our patients are in need. Although they see the need, others have given up on trying to get comprehensive change. For them, incremental changes appear to be the only direction feasible in today's political climate.

These well-intentioned people pursuing the route of noncompre-hensive incremental change are pragmatists, as I am also on certain days. Many of them have become discouraged and have lost faith, at least temporarily. The vested interests may have more cynical reasons for encouraging incremental change. They appreciate that such limited tweaking of the system will basically maintain the status quo and thereby assure the present balance of power and profits.

The types of progressive or "sequential" incremental change that could lead to universal coverage could be measures that are all-inclusive of a specific age group of our population. For example, we could put all children, or all people aged 55-64, in an expanded Medicare as a first step. Similarly, a state-by-state strategy (as a first step) could also work as it did in Canada, but it would be much more difficult because of the legal hurdles that would have to be overcome. At least these kinds of approaches would obviate the gaming of the system that excludes the sick and the poor.

But we can look at national health insurance or Health Care for All as a type of incremental change. A major step forward, but not a panacea for all that ails our health care system. It would be a boon for access to care. It would be undoubtedly the most essential step in 234 decreasing health care disparities in America. But it wouldn't necessarily guarantee access, let alone good quality care. Look at Medicaid, for example. People with Medicaid—and Medicaid can have a very comprehensive benefit package—often have a difficult time finding physicians.

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