The past century brought an astounding increase in farmers’ productivity. It created economic instability and brought the virtual abandonment of many rural Southern farming towns. But the development of U.S. agriculture is overall a great success story. And there are significant lessons in it for those of us in health care today.
Tractors and Medicine
In 1900, one-third of the U.S. labor force worked in agricultural production. In 1950, food consumed at home was 22 percent of a household’s disposable income. By 1998 that percentage had dropped to 7 percent. This dramatic decrease in the cost of food was directly attributable to improved productivity through implementation of technology.
This transformation of agriculture threatened many people’s livelihoods, particularly the small farmer. Farming turned into a “get big or get out” scenario, which made it difficult for small farmers to compete. Many farmers banded together to form organizations and trade associations to protect their interests. Laws were enacted to attempt to alter free market dynamics.
Innovative change always results in winners and losers, but artificially limiting productivity and restricting technological advancements through regulation simply means innovation will occur in markets outside the United States.
In the U.S. agricultural industry, technology has created efficiencies that allowed smaller inputs to generate exponentially larger outputs. To the dismay of mule breeders, the reliability, versatility, and affordability of the tractor drastically increased production. The free market, not government regulation, was ultimately the vehicle for this transformation.
The nation today faces a similar challenge in medical supply and demand. With ObamaCare implementation taking the lead, the debate in recent years has been focused on health insurance coverage. It would be more appropriate, however, to define access to health care as access to physicians.
The best-insured individual with a maxed-out health savings account (HSA) who is involved in a car wreck in rural Georgia is unlikely to have access to a neurosurgeon. Yet an uninsured homeless person who sustains a gunshot wound to the head in Atlanta and is taken to Grady Memorial Hospital could very possibly have access to the renowned Dr. Sanjay Gupta.
Managed care was ultimately a failed experiment in the late 1980s and 1990s because it was centered on rationing supply. It turned primary care doctors into gatekeepers who were financially rewarded for referring fewer patients to specialists. There were no rewards or incentives for greater access, efficiencies, or better outcomes.
Supply is further limited by an onerous regulatory environment, a focus on medical malpractice, and the insurer managing the payment process. It should be focused instead on informed patients who are responsible for their own health care expenditures. The right approach is to reduce demand by empowering patients with information and access, not to limit supply.
Access Without Doctor Visits
Empowering consumers is not simply about health care transparency. It’s about putting the decision-making and purchasing power in the hands of the patients. And it’s about bringing doctors back into the proper relationship with patients.
The agriculture industry has had no problem meeting demand. Did they train more farmers? Just the opposite happened—innovation and implementation created economies of scale. Without the productivity boom that occurred in farming, Harry Truman might never have left his family farm to become our 33rd president.
There needs to be a commitment as a society to focus on rewarding the innovations that only occur in free markets. Everyone wants higher quality, cheaper, more accessible health care. The answer is a return to the simpler days of free-market care.
There needs to be a return to the town doctor showing up with his or her medical bag. For this to happen in the United States, however, requires an environment that embraces innovation.
For example, a medical school classmate is now performing percutaneous valve replacements. The technology was developed by an American company, but onerous health care regulations here drove the procedure overseas to Europe, so he was forced to perfect his training in France.
This nation’s success in agriculture reinforces the need to seriously rethink health care regulation. It’s time to encourage, not restrict, the implementation of new technologies that will address the physician shortage and fundamentally transform health care in the United States.
Better Leveraging Needed
It’s time to revisit the issue of physician supply. The answer is not simply more physicians and/or medical schools. At its core is a need to leverage physicians better. It is possible the physician shortage is largely an artificially created shortage; meanwhile, malpractice and regulatory issues are diminishing the physician supply.
The solution lies in making the existing physician workforce more efficient and effective. A government mandate that everyone purchase insurance will not increase supply or reduce demand. Access to health insurance is not the same as access to a physician. Patients will still have the same needs, and physicians will be needed to meet them.
Physicians must be able to leverage technology and become more productive. For physicians, the metaphorical tractor may well be telemedicine. For widespread implementation of telemedicine to take place, however, the regulatory fences must come down.
It’s time for health care policymakers to ask, “Where are our ‘tractors’ and why are we still using ‘mules?'”
Dr. Jeffrey Grossman ([email protected]) is an Atlanta-based pain management physician (peachtreespine) whose practice has conducted at least 100 telemedicine consultations.