“Reforming” the US Healthcare “system”

Peter Jones Wu Wei

First off, its not a system, and we should reclaim our correct use of the word. It is a system in the way officials like to call the incarceration process the “justice system.” System dignifies this mess as if it were an assembly of planned processes directed toward beneficial outcomes. And the way we toss around the word reform suggests there was a form to re. Messes like this require a primary act of intentional design. Intentional systemic design starts with framing (and reframing) the concern people have that will be the target of design. And today, we have a good one.

Dr. Andrew Weil reframes the entire healthcare reform “debate” happening in the political arena. By identifying a systemic root cause (a diagnosis) of one of the largest-scale concerns ever to be embraced in politics and society, Dr. Weil has cut through the bullshit and redefined the conceptual frame.

“But what’s missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what’s even worse than its stratospheric cost is the fact that American health care doesn’t fulfill its prime directive — it does not help people become or stay healthy. It’s not a health care system at all; it’s a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly.

So, a far more salient question that must be addressed is: Are we getting good health for our trillions? Unfortunately, the answer is a resounding, “No.” The U.S. ranked near the very bottom of the top 40 nations — below Columbia, Chile, Costa Rica and Dominica — in a rating of health systems by the World Health Organization in 2000.”

But do we even have the possibility for engaging in this reposition of the discourse or framing? Instead, in modern America it would we have reverted to a pre-Colonial civil breakdown of incoherent disruptions and media-manipulating distractions across the country, exemplified by the so-called “town hall” meetings. Colleagues  at the National Coalition for Dialogue and Deliberation are recommending ways these listening, dialogue, and debate situations could be handled. They are volunteering to facilitate. So far, the Obama people are controlling the situation, which also worries me. Neither side is listening right now.

Dialogue leaders, like designers, often work on call to client needs, whether civic, social or commercial. At some point we also need to step into the fray as stakeholders in our own communities and speak up.

Designers working on systems-level problems (the design thinking school of design) are at a similar disadvantage. We have tools for change, but (often) no real stake in the game. Design/thinkers are new to these concerns. Just a few years ago, most of us were not available for social issues, as we were too busy helping our clients make the bubbles rise.

So do we really have “nothing but a method” to offer? Is design thinking enough? We are facing a sociopolitical crisis situation without a lever for real action. We have no national leadership and no recognized voice.  A Dr. Weil can speak with credibility, primarily as a physician and not because he is a media figure. Who do we have in our field who can speak with national authority? (I would offer Dave Woods or Gary Klein, but they are considered human factors and not design professionals.)

So where do we begin to participate in the participatory design of democratic concerns? How might we get ahead of the problem to reframe it? We have to start by being creatively engaged citizens with a local voice.