STEVE INSKEEP, Host:
It's MORNING EDITION from NPR News. I'm Steve Inskeep.
RENEE MONTAGNE, Host:
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: Welcome to the program.
ATUL GAWANDE: 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?
GAWANDE: 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?
GAWANDE: 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.
GAWANDE: 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.
GAWANDE: You're right. I talked to the extension agent from my home county in Athens, Ohio. And...
INSKEEP: Farm extension agent?
GAWANDE: 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.
GAWANDE: Thank you.
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