Health care hope

Most everything we've been reading about the health care legislation is sour. Even supporters are not sounding encouraged by the prospects of a bill getting through. The debate over the so-called public option is especially dispiriting - the Congressional Budget Office estimates that only 2 percent would opt for the public plan and yet it has dominated the debate. What finally emerges is certain to be a hodgepodge. But perhaps a hodgepodge is what we're looking for.

That's the intriguing - and somewhat hopeful - take by The New Yorker's Atul Gawande, whose articles on U.S. health care have been among the most insightful I've seen. In his latest piece (Dec. 14th issue), Gawande says that for all the flaws in the legislation now being considered, there are any number of pilot programs worth keeping an eye on. Pilot programs? Where's the master plan? Well, there is no master plan, and Gawande says it's unrealistic to expect any single plan to solve an immensely complicated problem. He then goes back more than 100 years to retrace another national crisis: agriculture.

In 1900, more than forty per cent of a family's income went to paying for food. At the same time, farming was hugely labor-intensive, tying up almost half the American workforce. We were, partly as a result, still a poor nation. Only by improving the productivity of farming could we raise our standard of living and emerge as an industrial power. We had to reduce food costs, so that families could spend money on other goods, and resources could flow to other economic sectors. And we had to make farming less labor-dependent, so that more of the population could enter non-farming occupations and support economic growth and development.

The government was called in, this time to help millions of farmers change the way they worked. He picks up on the success of Seaman Knapp, who worked for the Department of Agriculture and came to the East Texas town of Terrell in 1903.

Knapp knew that the local farmers were not going to trust some outsider who told them to adopt a "better" way of doing their jobs. So he asked Terrell's leaders to find just one farmer who would be willing to try some "scientific" methods and see what happened. The group chose Walter C. Porter, and he volunteered seventy acres of land where he had grown only cotton or corn for twenty-eight years, applied no fertilizer, and almost completely depleted the humus layer. Knapp gave him a list of simple innovations to follow--things like deeper plowing and better soil preparation, the use of only the best seed, the liberal application of fertilizer, and more thorough cultivation to remove weeds and aerate the soil around the plants. The local leaders stopped by periodically to confirm that he was able to do what he had been asked to.

The year 1903 proved to be the most disastrous for cotton in a quarter century, because of the spread of the boll weevil. Nonetheless, at the end of the season Porter reported a substantial increase in profit, clearing an extra seven hundred dollars. He announced that he would apply the lessons he had learned to his entire, eight-hundred-acre property, and many other farmers did the same. Knapp had discovered a simple but critical rule for gaining coöperation: "What a man hears he may doubt, what he sees he may possibly doubt, but what he does himself he cannot doubt."