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The similarities will save us: farming and practicing medicine
I’m completely fascinated by Atul Gawande’s most recent healthcare writing in The New Yorker. Nearly everyone has an opinion on what’s going to make healthcare better (nearly everyone has their own definition for that, too), but no one truly knows what is going to fix anything, it’s just a whole lot of speculation at this point. There’s a lot of (informed) guessing involved.
So what to do with healthcare problems that are so numerous and diverse? Throw the book at them. No one single approach. Try a bunch of stuff, change on the fly as results roll in, and spread solutions far and wide once effectiveness is proved.
That’s what the Senate bill is trying to do, writes Gawande. He compares the effort to agriculture’s government-run extension program (a program that is responsible—to a large degree—for reducing the share of the average American household’s percentage of income spent on food from 40 percent to today’s 8 percent as well as spreading sustainable agricultural practices that reduced cost and improved efficiency). It’s really neat; and being a proud-of-where-you-came-from Midwestern guy that has a little bit of knowledge about programs like this, I am completely onboard with the idea.
The admission that healthcare is a locally flavored (and distributed good) and will remain that way for some time to come is an important reality, too. It requires local implementations of well-researched solutions. Here’s a bit from the piece:
Getting our medical communities, town by town, to improve care and control costs isn’t a task that we’ve asked government to take on before. But we have no choice. At this point, we can’t afford any illusions: the system won’t fix itself, and there’s no piece of legislation that will have all the answers, either. The task will require dedicated and talented people in government agencies and in communities who recognize that the country’s future depends on their sidestepping the ideological battles, encouraging local change, and following the results. But if we’re willing to accept an arduous, messy, and continuous process we can come to grips with a problem even of this immensity.
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