YOU CAN PREDICT THE TRAIN CRASH
What Happens When A Simple Problem Collides With An Extremely Complex Solution
In his book, “The Checklist Manifesto,”, author Atul Gawande points out that there are three categories of problems: simple, complicated, and complex. After a decade of research and several years testing my decision-making framework against all levels of important decisions, I completely agree.
For example, a simple problem would be figuring out the location of a store by looking at the mall directory. A complicated problem would be figuring out how to send a rocket into space. This requires a deep knowledge of physics, math, liquid fuels, materials, etc. However, once you have correctly performed these complicated tasks, you could probably replicate them with only a minimal amount of new knowledge. A complex problem is one that is complicated, but not easily replicated. A complex problem requires a customized solution each time.
Here is a general rule of decision making: If you have properly sorted your problem into the appropriate category, the solution should come from the same category. A simple problem requires a simple solution. A complicated problem requires a complicated solution. A complex problem requires a complex solution.
Now let’s apply this rule by objectively looking at the Affordable Care Act (“ACA”), also known as Obamacare. Take a deep breath and tTry not to let your pre-existing political prejudices, whatever they are, come into play. I will make some assumptions here to strip away the emotional political issues and focus solely on the decision-making aspects of the law. Even if you don’t agree with these assumptions, making them simplifies the analysis. By the way, in full disclosure-- I voted for Obama.
Assumption 1:
It is the moral obligation of a developed country like the United States to ensure that all people can obtain excellent healthcare regardless of their economic status. A person who is unemployed or otherwise not able to pay for healthcare insurance should receive the same healthcare coverage as a person making $1 million a year.
Assumption 2:
It is important that people with pre-existing medical conditions be able to get healthcare coverage to deal with their issues.
Assumption 3:
It was the right priority at the time - that the ACA should have taken priority over an infrastructure bill that would have remedied our collapsing bridges and tunnels and created jobs. These assumptions mean that: the ACA was done at the correct time and that the underlying important foundations for the ACA (healthcare coverage for those unable to afford it and/or with pre-existing medical conditions) were the correct ones.
Pretty simple so far…and that’s the point. Don’t confuse important with simple. The core fundamentals underlying the ACA are extremely important, but simple.
Depending on how big the print is and mostly which party you are from, the official page count for the ACA is estimated to be between 1,800 pages to 1,990 pages. One political party estimates it to be longer to make it seem more overwhelming, and the other political party estimates it is shorter in order to have the opposite effect. To make my point clear, let’s say that the ACA is only 1,500 pages long. In fact, it doesn’t matter if it was only 1,000 pages long. It is still a classic example of an exceedingly complex solution designed to solve a simple problem. That is never the right decision process.
Do I know for a fact how the ACA will ultimately play out? No. None of us do. It is a future event. However, the caliber of a decision is judged at the time it is made based on the facts that are known or should have been known. Even though I voted for Barack Obama, ever since the time this law was being enacted and to up to today, from an objective decision-making point of view, I judge the law as a flawed decision. It isn’t merely suboptimal. It is a colossally poor decision.
How could the solution to these important but simple problems be crafted? I am not a healthcare expert, but we already had (and still have) a program designed to help people with limited resources – Medicaid. If Medicaid doesn’t work, fix it to work for not only people with the lowest income, but also people who are slightly better off but still need economic help. What about those with pre-existing conditions? Health insurance is on a state-by- state basis, just like car insurance. Since the states already require insurance carriers to cover even bad drivers in a “high-risk” pool, why can’t the same thing have been done for people who are higher health risks for insurance companies? Regardless of whether my suggestions are perfect, my proposed solutions are in the right category—simple.