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Monday, November 26, 2007

Muddling Through

Yale Professor Charles Edward Lindblom made something of an academic splash when in 1959 he published an article suggesting that ‘Muddling Through’ was a better way of dealing with social issues than the ‘Rational-Comprehensive’ approach then popular among political scientists. His basic argument, as I understand it, was that social issues are simply too complex to be contained within any rational and comprehensive theory and so are best dealt with incrementally by trial and error.

Long-time friend Bill Busby recently sent me a clipping from the Albuquerque Journal, reporting on a speech made by consultant Brian Klepper to the Albuquerque Chamber of Commerce Regional Policy Forum. Klepper argued that the current health care system is economically unsustainable and must ultimately be reformed by the businesses that are paying a large portion of the nation’s health care bill. He opined further that the reason it hasn’t happened up to now is that business is intimidated by the power of the health care industry.

I think there is merit in what he says. I would add that the health care industry is powerful because it enjoys so much popular support. Everybody complains about high cost and poor results, but when somebody tries to do something about it, like limiting choice of physician and putting restraints on medical decision making, people get their knickers in a knot and both business and government back off. That is what happened with managed care in the 1990s.

Klepper’s presentation was weaker when it came to suggesting what exactly it is that businesses might do. He mentioned things that needed to be done, like avoiding expensive treatments that do more harm than good and making better use of information technology. He also gave examples of some institutions that had done some very positive things in terms of improving quality and controlling cost. But he didn’t specify a course of action that businesses might adopt.

I think that what businesses need to do is to search for ways to use the power of the purse to pressure the providers of healthcare to improve their performance while at the same time persuading the employees for whom they are providing health insurance to tolerate some unpopular measures. Experts like Klepper would be more helpful if they offered some specific suggestions on how to do that. Businesses could then experiment with those suggestions to see which ones worked and which ones didn’t.

That may be muddling through, but it’s probably the most promising way to go.

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