I still don’t get why we keep focusing on technology as Obamacare’s main problem, when technology problems are more likely the outgrowth of more fundamental issues.
An early lesson I learned as a management consultant is that systems modeled after a crap strategy and equally bad business practices mean you will have chaos on your hands – much like what you’re currently seeing with the healthcare.gov rollout.
I tried to illustrate my point by pulling together a cursory diagram that explains how the best systems in the world are born:
As you can see, it all begins at the bottom, where you have to first figure out the problem you’re trying to solve and how you will solve it. There’s plenty of work to be done before you can even THINK about making sure your website has sufficient pipes to handle inquiries and transactions.
Perhaps Obamacare, or the strategy layer, solves the wrong problem or addresses the problem in a sub-optimal manner. As I recall, the problems to address are rising insurance premiums, healthcare-driven government deficits, and tens of millions of uninsured Americans.
The health insurance exchanges were created as a punk solution to avoid cutting out the insurance companies as middlemen. Disintermediating the health care firms would have made a single-payer universal healthcare system a realistic outcome, but enabling Obamacare’s circumvention strategy requires a massively complex system charged with informing and enrolling the uninsured while accounting for various geographic, business, user and policy domains.
The exchanges do not look like the most efficient way to solve America’s healthcare problems, not to mention that Obamacare still leaves many uninsured Americans without insurance.
How’s this for addressing the problem of insurance premium increases—Obamacare may result in millions of people currently insured to lose their plans and who will likely have to purchase obscenely more expensive plans.
Well…Team Obama seems to be aware of that last point so even if they didn’t have enough compassion to address the inevitable flood of incumbent policy cancellations, I suppose they could at least build sufficient capacity in healthcare.gov. But again, since the fundamental problem was never addressed at the strategy layer…
The shame in admitting fault and restarting the strategy exercise is not nearly as bad as the frustration and integrity problems created by attempting to automate a bad policy…
song currently stuck in my head: “i’ll change my game” – fonzi thornton feat. bernard edwards & nile rodgers