2009-11-24 05:45:14 - Tuesday marks the 150th anniversary of Charles Darwin publishing The Origin of Species. In the century and a half since its publication, the theory of evolution has evolved quite a bit. The fundamental concepts that Darwin helped discover have expanded into fields like psychology, economics, network theory, and more.

Evolution can explain why the American health care system is ailing, and can points to solutions to help our system adapt to its current challenges. "Evolution is progressive adaptation," wrote R.A. Fisher, "and nothing else." Philosopher Daniel Dennett explains evolution as a universal algorithm that helps discover "good tricks" for efficient living. By understanding how it works, we can help our health care system find "good tricks" to lower costs, improve quality, and accelerate innovation.

The first lesson is that the catalyst for evolution is freedom of choice. Freedom of choice is not just some abstract political bromide, but an essential catalyst for social, economic, and political adaptation. Ernst Mayr, the famed biologist, argues that advanced evolutionary systems thrive with

increased "choice and freedom of response."

Evolutionary psychologists Leda Cosmides and John Tooby argue that natural selection has equipped the human mind with the ability to evaluate options "in exquisite and often inarticulable detail", and as a result, individual choice can find the public good more effectively than an external planner. "Displacing value-guided decision-making to remote institutions", the scientists conclude, "systematically damages social welfare."

Unfortunately for us, American health care specializes in displacing value-guided decision-making to remote institutions.

The problem begins with America's antiquated system of employer-provided benefits, where your boss chooses the coverage he wants you to have. This coverage usually involves some large insurance company, who further dictates which doctors and hospitals you can see. On top of all that, the government accounts for 46% of all health care spending, with Uncle Sam even further dictating what procedures you'll have access to. All of these choice-restricting laws and third-party payment systems prevent the "natural selection" process from taking hold, which reduces quality and efficiency.

Biologists have long known that variation (i.e. multiple options) aids adaptation, and the same is true for health care. Recently, health researchers Atul Gawande, Donald Berwick, Elliott Fisher and Mark McClellan analyzed 10 of the most effective health providers in the nation. What they found was that there were no universal "best practices" that all ten of them shared. All had different payment methods, service delivery techniques, and value-added proprietary innovations. This shows us that can't just copy the Mayo Clinic's or Cleveland Clinic's practices; we can only create an environment that will let future Mayo Clinics or Cleveland Clinics evolve.

How can we reform the system to encourage health care evolution? First, we need to individualize health care spending. Existing employer-based health compensation can be diverted into a tax-free health care account controlled by workers, who would then be free purchase insurance coverage from any state. Coupled with existing Health Savings Accounts for out-of-pocket expenses, this system would measurably increase competitive feedback to help bring down prices and increase quality.

Second, we need to remove the tax and regulatory barriers to consumer choice in health care. State laws require all insurers to offer a smorgasbord of procedures that individuals may or may not actually need, adding hundreds or thousands to the costs of premiums for everyone. Additionally, "certificate of need" laws prohibit hospitals from opening or expanding their services without prior approval of bureaucratic overseers. A first step toward a solution would be giving doctors, hospitals, and clinics the freedom to compete and offer their own options.

Third, we can take care of those who truly need help by having supplementing the personal accounts, similar to the way unemployment insurance works. In this way, we can address the problem of the uninsured without interfering with the free evolution of American health care.

On the sesquicentennial of the greatest scientific discoveries of all time, we can all thank Darwin for providing an independent solution to this pressing issue.

About Matt Harrison:
Matt Harrison is the author of The American Evolution: How America Can Adapt to the Political, Economic and Social Challenges of the 21st Century and the founder of the Prometheus Institute (www.ThePrometheusInstitute.org) dedicated to discover independent policy solutions to reduce the burden of government on the people and to creatively market these ideas to citizens in order to create the political demand for positive change.