November 13, 2010 — Health Care, Part 2


In the last section we examined the health care situation and determined that, yes, everything is really screwed up. We’ve been working at it for about sixty years, and we’ve done a pretty good job of it. But, along the way, we have developed a medical industry in this country that is the envy of the world. We simply can no longer afford it. What to do, what to do…

Unfortunately I don’t have the magic elixir, the silver bullet, the fountain of youth, or any other miraculous solution to the problem. I do, however, want to suggest an approach which may yield something workable. Second only the phrase “I’m from the government, and I’m here to help” in producing terror is “I’m from IT and I’m here to help.” However, a generation of failed projects and wasted money (huge amounts in both cases) has taught IT a thing or two about problem solving. After fifteen years of hard work in my organization, we have reached the stage where we rarely have a project fail. In fact, we recently completed a million dollar project without a single change order. This is a measurable result of the adoption of best practices, and I believe we are not alone in this experience.

Aha, we are finally getting back to technology management. Correct. This becomes a basic lesson in Business Process Management and analysis. First of all we must ask the question: What are we trying to achieve? While we are thinking about that one, we can have a discussion on what the second question should be. There are probably several good ones, but the one I suggest is: What is the budget? The answer to the first is easy – we want to achieve universal health care. The answer to the second is more problematical. The recent election (among other things) indicated that the budget amounts Congress had in mind were too much. The reaction of the populace was rather emphatic. Let’s leave that one and come back to it later.

Let’s get back to the first question. Everyone is likely to agree that Universal Health Care is a worthy goal. The problem is that there are practically as many definitions of the term as there are consumers in this country. In order to devise a program to meet the goal we have to develop a working definition of Universal Health Care. So let’s define it as “adequate access to primary care.” I would argue we already have this. Most everyone in this country can scrape up the $80 to visit a doctor. I will concede that if you have small children, you will be making almost weekly trips to the doctor and that can get expensive. On the other hand, when I was a small child, I survived handily without those regular trips to the doctor. In fact I could count on one hand my encounters with a doctor before I was in high school. And the infant mortality rates in this country were not significantly worse in the 1950’s than they are now.

Okay, so I have apparently not defined the goal well. Let’s try again. How about if we define Universal Health Care as “any medical services necessary to keep me alive.” Now, my assignment to you is this: think about this definition over the next week and try to decide if (1) it makes sense, and (2) it covers the topic.

What we are doing are the first stages of facilitation. In order to solve business problems, IT has developed a whole series of practices that help in clearly identifying the problem, defining and making sure everyone is in agreement on the definitions. You cannot solve problems if you don’t know exactly what they are. This caused numerous project failures all through the history of IT and is now doing so in the health care debate.

We’ll come back to this again next week. I think it will be fun.

Contact Marvin at