The Absence of Ideas Has Consequences

In August the Commonwealth Fund?published its assessment ?and comparison of ‘management performance’ of health care systems in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The topline – that the United States “trails far behind other high-income countries on measures of affordability, administrative efficiency, equity, and outcomes” – is notable not as a novel insight, but as an indicator of strategic atrophy and stagnation buried deep in the bedrock of a $4 trillion health economy.

The American way of healthcare has become disfigured and disoriented from decades of incessant peripherality of the language used to describe it. We have normalized cliché, not just clichés of the pen, but clichés of the mind. Markets are fragmented and focused on promoting the technical merits of point solutions and selling the “value” of their inputs individually, not cohering on outcomes as the organizing idea for economic competition. Throughout our nation’s ‘healthcare-industrial complex’ there is a gravity field of expert “knowledge” that is inadequate creatively and intellectually to shift the psychic structure controlling legacy narratives. Our brand is “crisis”, which we have been?repeating ad nauseum for more than 50 years .?

From the Commwealth Fund:

“With the COVID-19 pandemic imposing an unprecedented stress test on the health care and public health systems of all nations, such a comparison [between the health care systems of high-income nations] is especially germane.?Success in controlling and preventing infection and disease has varied greatly. The same is true of countries’ ability to address the challenges that the pandemic has presented to the workforce, operations, and financial stability of the organizations delivering care. And while the comparisons we draw are based on data collected prior to the pandemic or during the earliest months of the crisis, the prepandemic strengths and weaknesses of each country’s preexisting arrangements for health care and public health have undoubtedly been shaping its experience throughout the crisis.”

The framing parrots the hand-wringing conclusions of a “crisis narrative” that has been a constant theme of healthcare content, beginning with one of the first ‘multi-stakeholder’ studies of health care, the results of which were released in 1969 by Richard Nixon:

“Ladies and Gentlemen, when this administration came into office in January, we initiated a major study of the Nation’s health care problems and programs. That study has now been completed….We face a massive crisis in this area; and unless action is taken to meet that crisis within the next 2 to 3 years, we will have a breakdown in our medical care system which could have consequences affecting millions of people throughout this country.”

We are a nation kinetically-trapped by an irresistible impulse to follow the machine that is already in motion, “leadership” unable to break a circularity of thought and inaction, helpless against the patterned energy baked into the system. Most healthcare content is a monotonous repetition of the obvious, positioning and message born from the same cognitive ingredients used to sustain momentum of the status quo. America is inured to bad news about its health because the worldview shaping it rides an air current of cliché.?

The real “crisis” is novel strategic thinking.

The skills gap is in creative leadership and ecosystem design, strategic imagination to snap a complex system of markets into a new orbit, where the ‘production of health’ as the measure of economic value. The not too subtle point using the Commonwealth Fund as the example (there are many, many others from all corners of healthcare, regardless of political bent, policy agenda or market context) is that the questions we are asking, the terms we are using, the ideas we are working with, the entire taxonomy of “healthcare” market strategy and innovation is still being framed within the matrix of an obsolete paradigm.

It is "nonversation" and it remains lodged deep within us, as a kind of comfortable mental furniture from which we are unable or unwilling to leave. We are back to what Marshall McLuhan called the horseless carriage syndrome, where lacking the words to describe a new phenomenon (the automobile), "we attach the new thing to an old frame of reference, unaware that the conclusions to which it leads are necessarily incorrect.”

/ jgs

John G. Singer is Executive Director of Blue Spoon Consulting , a global leader in strategy and innovation at a system level. Blue Spoon was the first to apply systems theory to solve complex market access and innovation challenges in the pharmaceutical industry.