outcomes!

Have you noticed that in most big projects you're a part of, success is measured by solving symptoms instead of creating outcomes? Off the top of my head the best example of focusing on outcomes is President Kennedy's proclamation: "I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the Moon and returning him safely to Earth."

JFK didn't talk about how it should be done, whether we'd use rockets or levitation, whether we needed bipartisan support, or anything else that reeked of symptoms. The outcome was clear, and while many thought it unattainable in 1961, the nation (and the world) held onto the goal and found a way to make it happen.

Seth Godin's post on positive thinking has a similar feel to it. We all suffer from NIH (Not Invented Here) syndrome, our natural reaction to someone else's ides is "why it won't work" vs. "let's give it a try!" This tendency creates barriers to outcomes that can become insurmountable, because for some reason, it's easier for us to believe in "no" than "yes." It's of course much easier to say why it won't work than participate and help create the outcome. Think of every "official opposition" in politics, and even why more candidates argue against their opponent than for their own ideas.

Health care in America is one example of this. Understandably, there is intense debate on this topic - it's complex, rife with vested interests, political rhetoric, and sadly, outright lies. The difference between health care and putting a man on the moon is that the former has been around for ages, affects everyone, and has a direct effect on each of our wallets. The latter had none of those constraints. These are all of course excuses for why we can't fix it...

What if President Obama's inaugural speech had said: "We will have universal health care in America while reducing overall costs before I complete my second term as President." (Note presumptive close on 2nd term;-))

The mandate does not require that we emulate European or Canadian systems, or that we will have a public option, or that we will cut this or increase that, or anything like that. As with JFK's mandate, the "how" is left up to the experts. The only constraints are what (universal health care), when (in 8 years), and how much (less than today).

Is it possible? I think so. What would this uniquely American health care system look like? I have no idea, Would there have to be compromises? Almost certainly. Does this country have a history of rising to the occasion? Yes.

I'm reminded of the scene from (ironically) Apollo 13 - see video to the right - where the NASA team had a problem to solve. The CO2 scrubbers on the ship were damaged. The team of engineers was essentially locked in a room, given exactly what the astronauts in space had at hand, and a deadline. Guess what as in the movie, they solved it in real life too.

Having no expertise in any aspect of health care (other than being a reluctant customer), I may have some ideas, but don't know enough about medications, insurance, HMO vs. private care, the role of physicians, nurses, etc. to respond intelligently. But I think if you put all these stakeholders in a room, lock the door and give them a deadline, we might get somewhere.

If I were in their shoes, I'd start with this: the system today succeeds when more people are sick than when less people are sick. Rather than figure out how to fix health care, why not look at what it takes to create a substantially healthier America??