Holly G. Green
One of the biggest dangers in business is MSU, or “making
stuff up,” especially when we don’t realize we are doing it. I see
leaders and managers do it all the time, and the consequences to
people and profits can be horrific. With the newly passed health
care bill, our entire nation is about to fall victim to a
trillion-dollar MSU that will impact our country for generations.
I am not saying our country does not need health care reform,
but how many are aware of and understand the underlying data that
drove the new bill? How many have questioned the assumptions and
beliefs being tossed around as “obvious”? How many are clear on how
the plan will impact us? And how many think this bill addresses the
issues they want addressed? And one more…how many people believe
this will cost us anything close to what is being projected?
A few data points to think about in regards to that:
At its start,
in 1966, Medicare cost $3 billion. The House Ways and Means
Committee estimated that Medicare would cost only about $12
billion by 1990 (a figure that included an allowance for
inflation). This was a supposedly "conservative" estimate.
Medicare actually cost $107 billion. By 1999, cost was $209
billion, 2005 $325 billion, 2008 $599 billion - 20% of federal
spending. Only Social Security and Defense were larger
percentages of the budget.
And then there
is that other little nagging piece of data on Medicare – the
system currently spends approximately $60 billion annually in
MSU happens when we don’t question or challenge our
underlying assumptions and beliefs about the way we see the world.
And it happens when we have strong beliefs that things will go
according to plans just like we outline them.
When we are caught up in MSUing, we make critical decisions
based on outdated, invalid information and strongly held (but
usually erroneous) beliefs, then wonder why our best-laid plans go
awry. That’s exactly what’s happening with the health care debate.
And it’s not just the Obama administration, it’s people on all sides
of the issue.
People are taking sides and making decisions based on their
assumptions and beliefs rather than on real data. Nobody is taking
the time to pause and ask, “What does the data say? What are we not
taking into account that needs to be considered?” Key players on
both sides of the issue are not exposing their own thinking
processes. Instead, they’re automatically assuming everyone
believes the same things they do.
What are some of the assumptions being made? One widely held
belief is that people are uninsured because they can’t afford
insurance. While this is certainly true for some, research shows
that many (especially young, single adults) are uninsured because
they choose not to buy insurance. There
is considerable debate on the causes and reasons for the large
numbers of uninsured, yet no one has taken the time to sort out what
the data really says.
There also seems to be a universal assumption that health
care is a right. Where did that come from? It’s not in the
constitution anywhere. Universal health care may seem like a noble
ideal. But when we see it as a right, we limit our ability to think
about it from multiple perspectives and angles.
Perhaps the biggest problem with health care is that it’s
such an emotional issue. As human beings, the more emotional we
get, the more vigorously we look for information to prove us right
and the more we tend to shut out any contrary data. In the absence
of real data, we make stuff up, which inevitably leads to bad
decisions with unintended consequences.
And that’s another thing that scares me about the way the
administration rammed the bill through. They didn’t take the time
to consider unintended consequences or do any scenario planning
around what could happen after the bill takes effect. They didn’t
ask questions like, “What behaviors does this plan incent?” Or,
“What if this happens?”
Just look at the amount of fraud in the Medicare system. The
government never intended for fraud to happen, so they never planned
for it. Now it costs us billions of dollars every year, and people
are ignoring the same issues in the health care debate.
Making stuff up happens all the time in business as well,
especially when companies have experienced a lot of success. Leaders
get emotionally involved in thinking they are the best. They become
devoted to existing products and the brand, so they stop looking for
ways to improve. They become convinced of their own brilliance and
stop listening to customers. Instead of being willing to pause and
ask, “What if?” they spend all their time trying to prove themselves
And that’s what worries me most about the government’s
position. They’re so committed to proving themselves right that
they just aren’t listening. Several polls have shown that the
majority of Americans did not want or approve of the current bill.
And yet, today it was signed.
Already, more than 13 states are lining up to challenge the
constitutionality of the law (another unintended consequence). And
there is a lot of speculation about what will happen, or not happen,
to those who refuse to purchase insurance. So there isn’t a lot of
clarity around how this bill will impact individuals and the nation
as a whole.
My hope is that going forward the government will do what
they should have done in the first place, which is pause, take a
deep breath, and say, “We need to slow down and take another look at
the data.” Just because the bill has passed doesn’t mean it has to
be set in stone. Let’s get a real plan in place – one built on data
and desired consequences. Let’s get clear on what the destination
is and the stops along the way. Let’s map out some key milestones
and build plans to get the right structures in place (anyone else
worried about the IRS being the agency of enforcement for
healthcare?). If this sounds to you like what you should do for any
company in a strategic plan, you are right. It is about time our
government applied winning practices to legislation and ways of
operating. If any public company behaved in the manner we have seen
the last several months, the board of directors and CEO would be
I believe that we can come up with a health care bill
that works for all. But not if we insist on making stuff up and
behaving as if there are no options, no other ways of thinking, no
diverse perspectives… Our government has to be willing to spend the
time to get this right. It is not enough to run. You have to be
clear on where you are running to and what it will take to win the
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