He writes,

The theory the country is about to test is that chains will make us better and more efficient. The question is how. To most of us who work in health care, throwing a bunch of administrators and accountants into the mix seems unlikely to help. Good medicine can’t be reduced to a recipe.

People engage in a lot of magical thinking about doctors. As a result, the average doctor has a much higher status quotient than the average restaurant cook. That makes it more difficult to embed doctors into management systems.

I have said before that the status of doctors in society has nowhere to go but down. The institutions that pay for health care (government and insurance companies) are not as susceptible to magical thinking, and they are becoming less responsive to consumers (who are happy to confer high status on doctors) and more concerned with budgets and results.

Gawande generally takes a favorable view toward adopting stronger management systems in health care. It is a long article, well written and worth reading. I agree with Gawande about the potential benefits of subjecting health care professionals to management. See Does the doctor need a boss?

However, you have to understand that the concept of consumers and consumer choice is alien to Gawande. He is deeply rooted in folk economics. He trusts individual agents, not market processes. He has a magical-thinking model of government.