What do health care reform and the ag extension service have in common? Quite a bit, writes Atul Gawande in the December 14 issue of The New Yorker magazine. Gawande reports that the health care reform bill now before Congress “has no master plan for curbing costs.” What the bill does contain, however, are a load of pilot programs aimed at cutting the cost of care. And that, he argues, may not be that bad a thing.
Which gets us to the extension service. Gawande tells the story of the U.S. Department of Agriculture’s effort to make farming more productive. At the start of the 20th century, 40% of a family’s income went for food, and food production required half the nation’s workforce. In order to become an industrial economy, these numbers had to come down, and they did, Gawande says, because of the extension service — which began as a pilot program.
It’s a good story, which starts in in a single county in East Texas with a single farmer. The first “extension agent” recruited one farmer in 1903 to try new farming techniques, and when that farmer had success, others followed. In 1904, the USDA added 33 extension agents. By 1920, there were 7,000. Farming got radically more efficient. Food prices dropped. It worked, Gawande writes, and it all began quite small.