I’ve been loosely following the healthcare debate in the U.S. and there are some obvious points for innovation gone wrong. It’s not Obama’s fault, at least not yet, as the system he is working in is designed to make innovation quite difficult. Big change of any kind, for better or for worse, is extremely hard to do as power is divided across so many people, with so many entrenched and selfish interests.
Given what I know about innovation, if I were tasked with the challenging of reforming U.S. Healthcare, the last thing I’d do is try to overhaul the entire system all at once. It’s too big, too complex, and has too many built in defenders of the status quo to ever pull off. It would also be much too hard to get right in one shot.
Instead I’d do the following:
- Inform the populace of examples that already exist that we can emulate. Innovation is less scary if people can see and talk to others who are already doing something. Which U.S. states or countries are closest to what Obama wants to do? I have no idea, yet I’ve followed the high level debate points so far. Many of the criticisms hinge on the belief what Obama wants to do can’t be done, yet somehow most developed nations in the world do provide a form of universal health-care. We are ignorant of how else this can work and it’s a flaw in American culture that we’re ignorant of other successful ways governments can run. I want to see a chart comparing the U.S. to Sweden, Japan, Canada, Germany, etc. so we know how else this has been done, and can learn from them.
- Run a pilot program so the risks are smaller. Pilot programs are the only way to take risks in a safe way and avoid criticisms driven by fear (see idea killers). If you take a small group, and apply the changes there, and observe the results, you create a way to learn from mistakes in the small, prove the core principles and gain support from people who say it can’t be done. It’s much easier to get support for a pilot project than for the real thing. You often can do it in some form with a minimum of approvals. Do a small one, show it worked, then repeat on a bigger scale until you have enough evidence to make your case.
- Insure more people every year instead of all at once. Another way to minimize risk is to grow the system over time. This is a form of pilot program – piloted over time. Instead of radically overhauling the system, increase coverage to 5% of the uninsured in 2010, learn from how that worked, then expand to %15 etc. By making changes incrementally there is less to fear and less risk of abuse, bloat, and mismanagement. And it reduces the costs risks many complain about.
But the problem with my advice is the U.S. government is not designed to make this kind of thing easy. Budget cycles and Senate processes do not encourage experimentation, and the momentum required to get any legislation passed at all is so complex and momentum bound that once in motion there likely will not be a second chance – you get one bullet to spend during a term as president, if that at all.
Many corporations suffer similiar systematic problems – there is so much required to even get an idea on the table, that big ideas become brain dead easy to kill if that’s what you want to do, which most people who already have power and seniority tend to want to do.
As is often the case for me in American politics, I’m worried less about which side wins whatever battle, than I am about the low quality of discourse and discussion. It’s hard to sort our how much the headlines reflect what is actually going on, but stupidity and arrogance are harder problems to fix than innovation. Whether at work or a town hall meeting, when many arrive with decisions already made, or with the goal of silencing others, there’s not much room for progress to happen.