Monday, April 9, 2012

Health Reform Too Complicated to Explain

the universe is too complicated
for me to explain

Do not tell me

said warty bliggens

that there is a purpose
in the universe
the thought is blasphemy
Don Marquis (1878-1937), “Warty Bliggens, the Toad,” From Archy and Mehitabel, 1927. Warty Bliggens was a toad who considered himself the center of the universe that existed to grow toadstools for him to sit under by light of day and moon  among the wheeling constellations.
I wish he would explain his explanation.

Lord Byron (1778-1824), Don Juan
April 10, 2012 -  Two health care items caught my eye today.
·        One, “Complexity Is Bad for Your Health: if Even Supreme Court J Justices Can’t Fathom Obamacare, Where Does That Leave the Rest of Us? (Gordon Crovitz, Media and Information Industry Executive, Wall Street Journal , April 10, 2012

·        Two, “Health Care Hustle: Patients Caught in Middle of High Stakes Numbers Game,” Scott Cohn, CNBC Senior Correspondent CNBC Report, April  10
The WSJ piece explains that the 2700 page health reform law is too complicated for ordinary mortals to grasp, even Supreme Court Justices,
The CNBC piece explains that the biggest and most overlooked factor behind rising health costs may be Medicare and Medicaid fraud, estimated at $80 billion and possibly twice that amount, and government seems helpless to stop it.
The two news releases bought to mind a favorite book of mine Edgeware: Insights from Complexity Science for Health Care Leaders, VHA Inc, 2998) by three complexity experts,  Brenda Zimmerman, Curt Lindberg, and Paul Pisek
Their thesis is that the health system is so complex that is produces chaos.  The maintain the system lends itself better to incremental  bottom-up  reform than top-down  centralized  all-at-once reform.
They maintain, to reform “complex adaptive systems” like stock markets, human bodies, forest ecosystems, manufacturing businesses, immune systems, termite colonies, and health systems, you should follow these nine principles.
1. Veiw your system through the eyes of complexity.
2. Build a good-enough system with minimum specifications.

3. Lead from the edge, not the center or the top.

4. Tune from the edge with just the right amount of information flow, diversity and differences, connections inside and outside the system, power differentials and anxiety.
5. Uncover and work with paradox and tension.

6.  Go with multiple actions at the fringes; let your direction arise from what you see.
7.  Pay attention to informal relationships; listen closely to gossip, rumors, and hallway conversations.

8. Grow complex systems by chunking, one step at a time.
9.  Mix cooperation and competition.
Otherwise reform results will be chaotic, incomprehensible, and impossible to carry out.

Tweet: Present national heath reform efforts are  too complicated to explain, comprehend, and implement.

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