Wednesday, December 16, 2009

Pilot projects in health bill could mirror success of Extension Service on farms, surgeon-writer says

As Congress moves toward a decision on health-care reform, one shortcoming often mentioned by Republicans is reliance on pilot programs to fix the ever-increasing cost of medical care. Mitch McConnell of Kentucky, the Senate minority leader, has cited pilot programs to reach the conclusion, "This bill doesn’t even meet the basic goal that the American people had in mind and what they thought this debate was all about: to lower costs." (And to cover the uninsured, we might add.)

Before dismissing pilot programs in favor of a grand solution, Congress should look to the success of such programs in U.S. agriculture, writes Atul Gawande, a surgeon and staff member of The New Yorker. At the start of the 20th century the U.S. was trying to improve farm productivity to raise its standard of living and reach its potential as an industrial power, Gawande reports. Instead of enacting grand solutions, like later Communist collective and scientific farms, the U.S. decided to begin its agriculture reform with a pilot program: the Cooperative Extension Service, funded by fedreal, satte and local governments. What started as one demonstration farm in 1903 expanded to the appointment of 33 extension agents the next year and eventually to 750,000 demonstration farms by 1930.

"There are, in human affairs, two kinds of problems: those which are amenable to a technical solution and those which are not," Gawande writes. He places universal health care in the first group, but says reforming agriculture or rising medical costs belong in the second. "No nation has escaped the cost problem: the expenditure curves have outpaced inflation around the world," he writes. "Nobody has found a master switch that you can flip to make the problem go away. If we want to start solving it, we first need to recognize that there is no technical solution."

Gawande contionues, "The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front. ... Government has a crucial role to play here — not running the system but guiding it, by looking for the best strategies and practices and finding ways to get them adopted, county by county. Transforming health care everywhere starts with transforming it somewhere." (Read more)

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