It's the season of miracles-and a time when it seems like we need several to pull us out of the messes we're in. Wars, failed banks and auto companies, jobs and "health care," the catchall phrase for a weight that grows even as others ease.
I just read that 46,000 Americans die prematurely each year, and that the number of medical emergencies resulting in bankruptcies has passed a million. And if it has not happened to us personally, chances are we know someone, some family struggling with an untimely death or medically induced financial disaster. Check the number of special accounts set up by "friends" of one victim or another at local banks.
My statistics come from an article in the New Yorker magazine written by my favorite health care commentator, Boston physician and Harvard professor Atul Gawande (and yes, he's an American, from Ohio). Gawande thinks that the problem of universal coverage can be ameliorated substantially with one of the grand plans before Congress-some problems do have technical "solutions." But the problem of cost is another matter: average insurance premiums have more than doubled in ten years to well over $10,000, medical prices continue to soar and the reasons seem multitudinous and intractable.
He finds hope in a small section of one of the Senate bills about "pilot programs" -and in the Agricultural Extension Service. The Extension Service was my road into Wallowa County all those years ago-so I read on.
According to Gawande's numbers, a hundred years ago we-Americans-were spending 40 percent of our income on food and half the labor force was working to feed us. And we were not the only country in the world struggling to feed a growing population and develop an industrial sector. Communist experiments in "scientific" farming and collectivization led eventually to massive famine, failure and the death of millions.
In our country, Seaman Knapp, who'd been a farmer, preacher, entrepreneur, and collector of seeds in faraway countries for the U.S. Department of Agriculture, was asked by the department to find ways to get farmers to raise more food at cheaper prices. So Knapp went to a Texas county and looked for a farmer to try new things-deeper plowing, more careful seed selection, liberal use of fertilizer, etc. In 1903 that farmer, Walter Porter, made an extra $700 on his 70 experimental acres while neighbors lost crops to boll weevils. The next year he used new methods on his entire farm and some of the neighbors joined him.
And the next year 33 "extension agents" were setting up demonstration farms across Texas and into Louisiana. In 1914 the Smith Lever Act established the Extension Service and agents were soon working in most counties in the country. The USDA began broadcasting agricultural information across the land on radio stations. It ran the first national weather forecasting service and introduced grading systems for meat, eggs, dairy products, and fresh fruits and vegetables.
As he says, "The government never took over agriculture, but the government didn't leave it alone either. It shaped a feedback loop of experiment and learning...for farms across the country." By1930 we were spending 24 percent of our income on food, which was produced by 20 per cent of our workers.
According to Gawande, there is no shortage of good ideas on medical cost reduction and no one, himself and his university included, knows which ideas will work best in which places. So he wants to let everyone experiment-and make sure the news gets around.
This is where miracles come in. I think that miracles don't come out of thin air, that what seems like something new and grand has roots, often humble roots. Christianity started in a stable on the shoulders of Judaism; centuries later a preacher named Nicholas in what is now Turkey stuffed a few pieces of gold into a widow woman's daughters' drying socks so that they would have dowries.
And the chronic shortage of rural physicians in Oregon was remedied in part when our Dr. Euhus explained it to the head of family practice medicine at Oregon Health Sciences, and he made a "rural rotation" part of required training.
My Christmas message to my congressman and fellow liberal agitators is to heck with the public health option. But grab Medicare for citizens aged 55. Medicare, the government program that most conservative seniors "don't want the government messing with," was once a child unwanted by many and now depended upon by most. Do away with pre-existing conditions and offer full health care at a reasonable price for 55 year olds this year-and, if it works, come down to 50 next year.
Distrust eradications, crusades, "wars" on drugs, poverty, terror and most other things. Especially distrust "final solutions." Pay attention to humble preachers and what goes on in stables across the land.