I write because it's my way of finding cool ideas, thinking through hard problems and things I don't understand, and getting better at something.

Our health-care morass is like the problems of global warming and the national debt - the kind of vast policy failure that is far easier to get into than to get out of. Americans say that they want leaders who will take on these problems.

You want to ensure people can do it right 99 percent of time. When we have to fire one of our surgical trainees, it is never because they don't have the physical skills but because they don't have the moral skills - to practise and admit failure.

Health care confronts us with a difficult test. We have never corrected failure in something so deeply embedded in people's lives and in the economy without the pressure of an outright crisis.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination.

The health-care sector certainly employs more people and more machines than it did. But there have been no great strides in service. In Western Europe, most primary-care practices now use electronic health records and offer after-hours care; in the United States, most don't.

The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front.

No one teaches you how to think about money in medical school or residency. Yet, from the moment you start practicing, you must think about it. You must consider what is covered for a patient and what is not.

People say that the most expensive piece of medical equipment is the doctor's pen. It's not that we make all the money. It's that we order all the money.

Oliver Sacks remains my hero to this day. He was one of the first medical writers I read. The other was Lewis Thomas, who is no longer alive but is just heroic to me.

Every country in the world is battling the rising cost of health care. No community anywhere has demonstrably lowered its health-care costs (not just slowed their rate of increase) by improving medical services. They've lowered costs only by cutting or rationing them.