Friday, May 23, 2014

Thinking Beyond Change

One of the challenges with the US Healthcare System [sic] is not in figuring out what needs to change, but rather how to implement such a change without completely tearing down everything and starting over from scratch.  Yes, tearing it all down would be very satisfying -- except to those who lost their lively-hood in the course of it.

That is the challenge.  Because any initiative to tear down a 30-year-old infrastructure will be opposed by those who are part of that infrastructure.  Any workable change strategy has to include everyone, and not write off any stakeholder.  It must provide for a mechanism to transition from one state to the next.  It isn't about figuring out the best way to do things, but rather, figuring out a better way to do things given where we are, and where we'd like to be.  This is not an engineering challenge, or not so much.  It's much more a political challenge.

Yes, you can be a great innovator and tell us how we should rebuild everything from scratch.  That's not going to be practical, nor is it likely to be implemented.  What I want you to do is show me how to get to a better place that just about everyone can support.  That's effective change, and damn it, that's really hard. It's very easy to design from a clean slate.  Our's has 30 years of chalk dust on it, and permanent marker, and chips and smudges that just won't come out.  Make it work with what we have.  That's where the real challenge is.  I love being able to deal with green fields.  But mostly we have today aren't just green fields, but cow pastures.  Be careful where you step.



  1. Thanking your for providing such a nice information
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  2. More than 30 years. Employer based healthcare dates back to at least WWII and the wage and price controls that were in place then. A lot of what people want to "fix" in healthcare involves de-coupling health insurance from employment.