By Frank Wessling
Could the American way of health care be improved by imitating the way great improvements were made in American agriculture during the 20th century? It’s a hopeful and well-grounded thought.
Our current struggle over health care, especially its cost, leads Dr. Atul Gawande to the analogy with farming. He is a Boston physician-educator and writer who has studied the contrast between highly effective health-care examples today — such as the Mayo Clinic — and the more common, inefficient and less effective example of everyday medicine and its insurance handmaid. He argues in the current issue of The New Yorker magazine for a look at the history of change in farming and food delivery.
What led us from the situation a century ago when the cost of food took 40 percent of the average family’s income to today, with that cost below 5 percent for a diet much more varied and safe? Gawande points to two principal factors: widespread experimentation and testing by farmers to find better methods, and the growth of an extension service by the U.S. Department of Agriculture.
Through the early decades of the last century, that agriculture department service expanded until there was an extension agent in thousands of counties throughout the country. This was the backbone of a quiet communication system that made a revolution in the production of our food. It was a revolution that could not have been foreseen or designed. It happened through freedom and encouragement to try new things — to have pilot projects — and a stable system for tracking and communicating information from such projects.
The same could happen in health care. The legislation being debated in Congress includes encouragement for a variety of testing and experimenting with different insurance schemes, different payment methods and different ways of cooperating among medical professionals. There is less of an effort to direct and manage health care in the legislation, Gawande notes, than a spur to get on with testing of better practices that serve more people at less cost — allowing a thousand flowers to bloom, as it were.
Gawande’s angle of view is useful for seeing how the messy, confusing work currently underway in Congress might carry great hope for the common good. It doesn’t get at fundamental moral questions such as funding for abortion. But it can reinforce our argument against tying health-care legislation to expanded government support for abortion, as the Senate bill currently does.
We could be on the threshold of an historic improvement in health care comparable to that in food production and delivery. This is too important to jeopardize by dumping into it an extraneous issue that divides the country rather than uniting it. Keep the current limits on government funding of abortion, as the House of Representatives did in its health-care bill.