Surgeon: Health Care Debate Can Learn From Farmers

Congress is moving closer to passing a health care bill that does not quite reach one of its major goals: guaranteeing some way to cut soaring health care costs. Surgeon Atul Gawande, who also writes for The New Yorker tells Steve Inskeep the current health care debate is reminiscent of the nation's farming debate at the turn of the century.

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STEVE INSKEEP, host:

It's MORNING EDITION from NPR News. I'm Steve Inskeep.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

We've been working to learn more about a reported deal among Democrats on health care. Key senators say they agree on the contentious plan for a public option.

INSKEEP: We don't know details, but one possibility here is that the idea for a government turn health care plan could go away. Americans could instead buy insurance through the federal agency that arranges private coverage for government employees.

MONTAGNE: That still leaves the problem of paying for health care, which we'll talk about next. The gigantic health care bill does many things, and critics say it fails to do much to cut our soaring health insurance costs.

INSKEEP: The surgeon and writer, Atul Gawande, thinks it may be fine to fudge that goal for now. He's written about this for the New Yorker magazine. He's on the line.

Welcome to the program.

Dr. ATUL GAWANDE (Surgeon): Thanks for having me.

INSKEEP: You point out that all the health care bills have are various pilot programs to explore ways to cut costs rather than mandates to cut costs for the most part. What example in history makes you think this could actually work?

Dr. GAWANDE: Well, the interesting part about it is that we've been through this before. A century ago we were in a situation where 40 percent of our spending was on another human need, and that was food. Forty percent of family incomes went to just paying for food and half the American workforce was tied up in farming. We were still a poor nation as a result, and we were as desperate about food costs then as we are about health care costs now.

And if you were standing at the start of that last century, just as we are now, saying what are we going to do about this, at the time what we came up with was just a bunch of pilot programs.

INSKEEP: What do you mean?

Dr. GAWANDE: Well, at the time we had some vague ideas that their - that farmers weren't as productive as they could be. We knew that they weren't plowing deep enough or we knew that they weren't rotating their crops, doing things that science had said, look, this would give you higher production, which would mean lower costs and better quality for farms and so on.

And we were very frustrated. We said we needed a fix for all this. And so what they began trying at the first half of the century in communist countries was, well, let's take over the farms. Let's do scientific farming. And we know what that led to was widespread famine, tens of millions of deaths.

The U.S. tried - instead of a grand, let's fix it all now solution, we kept the private farms. We had individual (unintelligible), but we brought government to try to help the millions of farmers to change the way they work.

INSKEEP: You actually trace it down to a single farmer who used - agreed to use a single piece of his land in Texas in 1903 to try some new techniques.

Dr. GAWANDE: Yeah, it was very interesting. It was a single pilot project. This government bureaucrat named Seaman Knapp persuaded farmers in Terrell, Texas to pick just one of their farms where they would try to produce food or in this case cotton at higher yield and lower cost. And the way that he went about it, is they found Porter, Roger Porter, who agreed to do it on a corner of his farm, and gave him a few things to just try.

By the end of the year, he'd made much more profit than all of his neighbors. The neighbors started saying, hey, we can do this, too. And the process then moved across Texas and Louisiana, where you had the extension service, extension agents coming in, helping farmers not just with cotton but corn and wheat and livestock, saying what are the best practices that your fellow farmers are doing and let's get you to just give it a try.

In supplying that kind of middleman role, the government ended up driving a process that within a decade and a half had cut the prices by half.

INSKEEP: You raise this very hopeful analogy to the way that farming was improved over the course of the 20th century. And yet I wonder if it would actually be easier to change farming than it would be health care. Because you could go - a guy could go to one farmer and persuade him to try one thing and have demonstrable result within a few months that other farmers could copy. Whereas, the health care system is this huge and interrelated industry with trillions of dollars at stake and a lot of people that would have to be persuaded to try even a small experiment.

Dr. GAWANDE: You're right. I talked to the extension agent from my home county in Athens, Ohio. And´┐Ż

INSKEEP: Farm extension agent?

Dr. GAWANDE: The farm extension agent. And he described to me that there are about 100 crops and livestock that he tries to make sure are being produced in ways that are becoming less environmentally harmful and are of high quality and good yield.

You look in my county and ask how many diagnoses do the doctors and hospitals take care of. It's more than 13,000. Organizing the care so we can make sure that everything from a breast cancer to a traumatic road traffic accident to a headache is cared for as well as possible following the evidence and organizing things so you don't waste any moves, do totally unnecessary things. There is no question in my home county or where I practice in Boston that we can do phenomenally better than we're currently doing. Imposing the solution on us is not going to succeed, but we don't have the pressure now to be able to solve it. The idea of pilot programs and incentives and experiments like these really are, is putting that pressure on us to begin reorganizing, really reforming health care.

INSKEEP: Atul Gawande is a surgeon in Boston and a writer for the New Yorker. Thanks very much.

Dr. GAWANDE: Thank you.

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