Thursday, October 30, 2014

Complexity May Kill ObamaCare

Complexity stalks through the land.


If ObamaCare follows the path of Prohibition , and dies off, or is repealed, it will be because it cannot keep pace with complexity – its inabilities to deal with complexities of regulating the law, enforcing its mandates, collecting its penalties, monitoring its billions of transactions, reducing health care costs, and preventing its frauds and abuses. It will be because ordinary consumers, policy experts, and health care providers are unable to comprehend, coordinate its promises, and to subdue or cope with its complexities.

The Hospital - An Example of Unbridled Complexity

A good example of the difficulties is the modern hospital. Peter F. Drucker (1909-2006) observed, “The hospital is the most complex form of organization ever devised.” It is made up of scores of specialists, each with a different agenda, different skills, different equipment, different jargon; its work forces, its managers and its health professionals, including its work force, 80% of whom are nurses, have different cultures; its customers, physicians and patients, have different sets of expectations, its supply chains are fragmented and it moves to the beat of different sets of regulations – local, state, federal, and professional.

Two Paths around Complexity

As I see it, there are two ways to circumvent or to minimize these complexities.

One is by reducing complexity and the technology that feed it. This can be done by escaping the confines of the hospital, and delivering care outside the hospital in decentralized settings. This is being carried out today in various ways – by setting up independent outpatient facilities, by treating ambulatory patients differently from bed-bound sicker patients, and in the case of physicians, by acting independently of the hospital, and providing direct pay, independent outpatient care free of third party rules and regulations.

Two is by using technology to simplify and consolidate existing technologies. This may seem like a contradiction in terms. But, according to a company called SAP (, it is possible to use technology to simplify technology. SAP is a cloud –based company serving 20,000 organizations and 263, 000 consumers in 190 countries. Its CEO, Bill McDermott says, “We can’t let complexity win.”

I cannot personally vouch for SAP, nor do I have affiliation with it. But I like SAP’s premise: that you can use technology to beat technology. To date, technology has both simplified and complicated our lives. If complexity can be reduced, from a platform in the clouds, as an overall simplifier, and if it can be used to save us from ovwerwhelming complexity for all rather than having complexity kill us all, I am all for it.

In the case of SAP, which just ran a full two page ad in the WSJ, I admire the work of its ad writer.

Here are samples of his/her prose:

• “The exponential proliferation of mobile devices, social media, cloud technologies, and the staggering amount of data they produce have transformed the way we live and work.”

• “Complexity is becoming the most intractable issue of our times, an epidemic of wide-ranging projects, affecting our lives, our work and even our health.”

• “Complexity comes at enormous costs – sixty three percent of executives cite complexity as a primary issue in escalating costs.”

• “If we simplify everything, we can do anything. We just need to run simple...It will generate new opportunities for innovation."

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