A Harvard University medical professor has remembered his roots in Athens, Ohio and is suggesting that the nation’s Cooperative Extension Service might be the vehicle for finding ways to curb health care costs and promote better systems for health care delivery.
Every Minnesotan serious about improving and reforming the health care system should read Dr. Atul Gawande’s article in the Dec. 14 issue of The New Yorker magazine. Minnesota and Maryland, and probably New York and Florida, are clearly the best-positioned states to make such a system work and to become the models for the rest of America. Wisconsin, Missouri and Illinois are not far behind, despite having expertise and facilities dispersed over multiple campuses; and California and Massachusetts have everything they need to make it work except an institutional tradition of cooperation through the Extension Service.
That’s getting ahead of the story.
Mary Thompson, communications director for the national Farm Foundation research organization in Chicago, called the other day to suggest Minnesotans take a good look at the Gawande article.
At the turn of the last century, food costs averaged 40 percent of American household disposable income and was holding America’s economic progress in check. Thus, Gawande writes, public investment in research and information sharing was started to make agriculture and the food system more effective and efficient. This public investment in research and information is the Extension Service that still links the so-called land grant research universities with most counties across America today.
How well has it worked?
USDA’s Economic Research Service, in a series on food expenditures by families and individuals since 1929, traces how food took 25.2 percent of disposable income in 1933, 20.7 percent in 1940, 20.6 percent in 1950, 17.5 percent in 1960, 13.9 percent in 1970, 13.2 percent in 1980, and 11.1 percent in 1990.
The series shows that food costs dropped below 10 percent – to 9.9 percent – in 2000 and has been trending lower in most years since. The ERS figure for food’s portion of disposable income in 2008 was 9.6 percent.
This is only one benefit of public investment in agriculture research and information sharing. Keep in mind that agricultural trade resulting from explosive agricultural production has helped keep America’s economy afloat with export earnings for the past century.
But Farm Foundation’s Thompson points out that health care is now doing to the American economy what food costs did at the start of the 1900s.
Documents and analysis pulled together by groups for the health care reform debates in Washington cite different measurements and data. But all show health care spending rising faster than growth of the nation’s Gross Domestic Product. Most show a trajectory in which health care costs will be 20 percent or more of GDP by the end of the new decade.
A Kaiser Family Foundation report [PDF] summarizes the burden this is becoming for households and individuals, and how expensive it is in America compared with other major developed countries. The report cuts through nonsense and disinformation clouding health care debates.
Gawande, meanwhile, argues in The New Yorker that the House and Senate health care plans don’t have a “master plan” for controlling costs. Neither did the government effort to increase food production a century ago, he noted. But the experimental farms and sharing of information did allow farmers all across the nation to learn better, more productive ways to farm, and for the whole food chain to make similar improvements in handling, logistics and nutrition.
Page 621 of the Senate’s health care bill obliquely calls for “pilot programs” which to Gawande sounds a lot like the Extension Service operations he saw back in eastern Ohio.
That’s what it sounds like to C. Ford Runge as well. Runge is an applied economist at the University of Minnesota and sees two reasons why the Gawande suggestion deserves close attention.
First, any federal effort to link the dysfunctional American health care system into an information network and pilot project sharing system will be costly, given the enormity of the task. “Why create a whole separate system when the Extension Service is in place?” he asks rhetorically.
His second reason is the historical role the University of Minnesota and the Extension Service have played in the state. It is a standby strength ready to be mined. The University is the federally designated land grant university and is the state’s main research university.
“We have every major area connected. The Extension Service has experience with all of them,” Runge said.
For readers unfamiliar with the University of Minnesota Extension Service and the national Cooperative Extension Service, their website offers a comprehensive overview.
Maryland is like Minnesota in higher education structures. New York, through the public and private Cornell University, and the University of Florida, are also similar.
Most states have dual public university systems. One is the land grant institution and its related academic disciplines that are centered in one or more related campuses. The other is a separate, major academic and research university housed in a parallel, and often rival, higher education system.
What this split means in most states is that agriculture, food, nutrition and even veterinary medicine are housed in one system while human medicine and public health programs are housed in the other. Minnesota does have a separate higher ed system in the Minnesota State Colleges and Universities system, and it is big in medical career education and training. But the two systems do work cooperatively in a number of outreach and public education areas, partly reflecting geographic realities of facilities and partly because the research component is largely housed in the land grant university system.
Going forward, Minnesota needs to explore how it might broaden and strengthen the Extension Service to perform greater medical and health care information sharing, information technology utilization, and provide rationalizing services for local public and private health care providers. This will need greater coordination and cooperation between the University of Minnesota and the MnSCU systems that are better geographically located across the state and have IT and other educators in place to perform new health care extension services.
Simply put, if the provision for “pilot programs” currently contained in the Senate bill becomes law, Minnesota should be ready to become the first pilot project. America needs what Minnesota can bring to the table now, just as it did with food, nutrition and agricultural productivity throughout the past century.