Health Reform Paradoxes

The idea that the central government – one huge mainframe – is the most important part of governance is obsolete.

John Naisbitt, Global Paradox:  The Bigger the World Economy, the More Powerful Its Smallest Players, William Morrow and Company, 1994

 Chunking – Grow complex systems by chunking by allowing complex systems to emerge out of the links among simple systems that work well and are capable of operating independently.

Edgeware: Insights from Complexity Science for Health Care Leaders, VHA, Inc, 1998

May 28. 2012 -  Yesterday  at the local library,  I stumbled upon John Naisbitt’s 1994 book Global Paradox.    As I scan it on this Memorial Day,  I remember it was Naisbitt  in his 1982 classic, Megatrends,  who reminded us what America is all about.   We are a a"bottom-up" society rather than a "top-down" nation,    yet  we believe ,through our miltiary,  in protecting the rights of individuals around the world. 

In Megatrends,  Naisbitt said we are going from:

1) an industrial to an information society
2) forced  technologies to high tech/high touch
3) a national to a world economy
4) short term to long term thinking
5) centralization to decentralization
6) instiutional to self-help
7) representative to participatory democracy.
8)heirarchies  to networking
9) northern to southerm  U.S,
10) either/or to multiple choices

These trends continue to the present,  and it is wise to keep them in mind as we try to impose  Obamacare reforms upon Americans.   Some  of its provisions limit choices and individuual freedoms. 

Accurate Track Record

Naisbitt has a historical track record of accuracy.   In Global Paradox,  he asserts “There will be no real union of Europe.” He predicts the European unit will fail because each country will seek to preserve its own identity, language, and customs.  

This struck me as prescient, so I read on.

 “As the world integrates economically , the component parts are becoming more numerous and smaller and more important...The almost perfect metaphor for the movement from bureaucracies of any kind  is the shift  from the mainframe to PCs, with PCs linked together…The desire for balance between the tribal and the universal has always been with us. Democracy and revolution in telecommunications  have brought  need for balance between tribal and universal  to a new level….E-mail is for tribe makers,  Electronics makes us more tribal  at the same time it globalizes us.”

Paradoxes

Naisibitt’s observations 18 years ago highlight the paradoxes of the faltering European Union and of Obamacare itself.

·         People want to retain their independence and individualism ,i.e,, their national customs and language, even while they are becoming more dependent on government. 

·         Cultural differences are important, even more so than the homogeneity and wealth distribution sought and engendered by idealistic progressive governments. 

·         The information revolution empowers individuals to seek information outside of government, to garner information by connecting each with one another, which in some cases, makes government-sponsored programs and information irrelevant.

·         People seek solace in more intimate relationships with each other and physicians, rather than with government-sponsored programs offering all things to all people.

·         People, according to Gallup polling,   trust each other and doctors more than big government or big health plans – even if big data indicates otherwise.

·         “We are, Naisbitt says, in the Western World,  in a ‘political crisis’ because leaders have ceased to become very important. Politics will remerge as the engine of individualism. It is a global shift from the state to the empowerment of the individual riding the wave of the telecommunication revolution, and the opportunities for individual freedom and enterprise are totally unprecedented.”

I do not want to overstate the case for individualism or for the Internet as health reform’s only change agent,  but I do think Obamacare may have overemphasized the importance of universal coverage at the price of individualism.   

A more incremental patient-centered approach, tethred to the individual rather than government,  may have worked better.

Naisbitt concludes,”A new technology is allowing companies to deconstruct, to radically decentralize, to push power and decision making down to the lowest possible point. Now citizens have the power to radically decentralize into direct democracies – free-market democracies. Centralized governments – in the metaphor, mainframe governments – must now yield to the periphery, to the PCs, the new leadership required in the world is to facilitate entrepreneurship, the contributions   by individuals, to facilitate the sort out of what will remain local and what will be global, what will remain global and what will be universal.”

Tweet: Health reform is a paradox in that individual empowerment, triggered by the  Internet,  has become more important than government itself in driving change.