On Universal Healthcare and System Design

Wonderboy's proposals, albeit hopelessly and dangerously vague, for universal healthcare got me thinking this morning about systems design.

I've had a fairly extensive career in large- and small- organizations. I worked for AT&T when it was a million people strong. I've worked in a small hedge fund shop of less than a dozen people.

In my AT&T and Chase Manhattan days, I was involved in plenty of projects which featured systems design, operation or redesign.

While not a veteran IT systems designer, I've had a fair amount of experience with general systems design involving people, organizations, processes, goals, etc.

From all of that, I've learned a few things.

One is, systems have to be designed to the least-competent people's level, because it's rare that systems end up being operated by geniuses.

Another, of course, is something sensibly taught in most IT management courses- start with pilot projects and pilot groups. Be honest and open about what works and what doesn't. I did pilot strategy assessment projects with product managers at AT&T. They were a small, highly-motivated, bright group of people. Even so, we changed things in the process of completing the pilot. It wasn't a rubber stamp exercise.

Finally, before designing a mega-system, it's a really good idea for the chief visionary/architect to have completed at least one smaller system design and implementation prior to 'the big one.'

Entire books, like Tracy Kidder's famous "Soul of a New Machine," have been written about the process. It's not a trivial undertaking.

Which brings me, of course, to Wonderboy's brand spanking new mega-project, universal healthcare.

Our First Rookie hasn't, to my knowledge, designed and implemented an extensive system before. As I understand it, he's a lawyer by trade, after having drugged his way through Columbia undergrad. He then 'organized' communities.

Nothing so far to suggest deep, extensive experience with even medium-scale systems design and development.

Now, add to this the fact that there are 50 states.

Doesn't it seem reasonable to insist that the Democrats, led by Wonderboy, should have a more-experienced systems designer doing universal healthcare? And perhaps one of the more zealous liberal Democratic Senators from say, New York, California or Illinois should visit the new mega-system on their state for, oh, say four or five years before we evaluate it?

Of course, you could look at the failed TennesseeCare program which had to be scrapped. Or the ailing and failing, ever-more expensive program in Massachusetts, unwisely fathered by former presidential candidate Mitt Romney. Or the California system that has engulfed the state's budget.

My point is pretty clear, though, isn't it? If something is so important, according to Wonderboy, as to affect even US business competitiveness, which has yet to be proven, isn't it sufficiently important to be done according to the 'best practices' which our president promises to use in the new healthcare system?

That would mean, for a start, naming a confirmed cabinet official with systems design and implementation experience to devise the new program, then choose one or two states on which to test it for several years.

Not pass a single, untested omnibus bill, authored by inexperienced (in systems design) Congressmen, egged on by equally an inexperienced president, to be simply unleashed on the nation without any testing?

This violates every best practice ever conceived. It's a disgrace to our nation.