Gerald Sindell Innovation

You’re third in line for take­off, finally ready to lift off from La Guardia and get to your lunch meet­ing in Chicago. The pilot comes on the P.A. for a last-minute cheery mes­sage: “Thanks for your patience. We hope to make it up one we’re in the air and get you to O’Hare on time. Or at least some­place not too far from there. We think­ing maybe Gary or Indi­anapo­lis. As the Pres­i­dent says, we shouldn’t make the per­fect the enemy of the essen­tial. So wish us luck.”

What if that were accept­able? What if we never got where we were hop­ing to go, and it was okay?

What are the impli­ca­tions when Pres­i­dent Obama tells us that part of his phi­los­o­phy is, “We shouldn’t make the per­fect the enemy of the essen­tial?” Sounds rea­son­able, in a way. Don’t want to be a per­fec­tion­ist about every­thing. Wouldn’t be real­is­tic. Never get any­thing done. Got to com­pro­mise, make a deal. Make progress of some kind.

I’m not so sure about throw­ing the per­fect over­board. I keep won­der­ing how can we ever know what really is essen­tial unless we first know what the per­fect looks like? Sure, when you’re going 500 miles per hour in an alu­minum can at 30,000 feet, essen­tial is you land in one piece, some­where. But when you’re on the ground plan­ning a trip, maybe the per­fect includes get­ting all the way to your destination.

You want to know why this coun­try is so con­fused about how to move for­ward on health­care? One rea­son is, no one has given us a vision of what the per­fect looks like. With­out the per­fect, we’re not even head­ing to Chicago and putting up with the real­ity that we might land in Cleve­land. Obama’s vision for health­care still feels to lots of peo­ple as if we’re just lift­ing off with no clear vision of where we hope to land.

Would you really want your team to design any­thing with­out first mak­ing the effort to get a clear pic­ture of what the per­fect might be? If we don’t attempt to imag­ine what the per­fect is, let our­selves dream and reach for the stars, then we are giv­ing up our great­est gift as human beings before we even start. With­out a des­tiny that we can see and dream about and hope for, what is to guide our efforts? The jour­ney of progress will be vastly longer if we don’t know where we’re going.

What if Frank Gehrey had lis­tened to that board mem­ber (whom I’m cer­tain existed), the one who said, “Now, don’t go all crazy Frank,” and never asked him­self what the Dis­ney Con­cert Hall should be like if he could cre­ate exactly what we wanted? What would I like the out­come to be of my open heart surgery? What kind of achieve­ments would you like to have in your life? Do you want to start by think­ing about all the com­pro­mises you’re going to have to make, or do you want to imag­ine what you want to do, first?

Now that I’ve won you over (at least for a moment) to the notion that we should try to imag­ine what per­fect would look like, let me invite you join me in imag­in­ing what would a per­fect health­care sys­tem be like? I, for one, would toss in the prin­ci­ples that every­one would have the health­care they wanted and needed. Peo­ple would be edu­cated about healthy choices, and the obe­sity rates would decline. Money in the sys­tem would go to care­givers. Over­head would be kept at a min­i­mum. Com­pen­sa­tion for doc­tors would incen­tivized qual­ity out­comes. We would shift from a sick­ness to a well­ness sys­tem. That’s top of mind for me.

What about you? You can add your own thoughts, or turn this upside down. But what­ever the dis­cus­sion, we need to be able to hold up for our­selves a clear well defined pic­ture of where we’d like to be some­day. Many peo­ple feel the per­fect is, “Sin­gle Payer.” But I think whether that’s it or not, we need to see how it would actu­ally be in real­ity. Maybe we even to imag­ine what would hap­pen if the health­care insur­ance indus­try were down­sized or shut down. I have no trou­ble see­ing it, by the way. I just imag­ine decom­mis­sion­ing old coal-fired elec­tric­ity gen­er­at­ing plants. Same thing.

What­ever our vision of the per­fect is we will be, finally, ready to design our com­pro­mises with “polit­i­cal real­ity” (which means work­ing with those Stake­hold­ers Who Are So Large That No One Can Say Their Name). And most impor­tant, look at those com­pro­mises and deter­mine whether they allow us to remain aligned with our vision of the per­fect, or if they take us far­ther off track.

With­out that clear pic­ture of where we want to go, we will never get closer to it. With that vision of the per­fect, we’ll always know what’s left to be done. That’s what lead­ers are for, by the way. To inspire us with a vision of the ideal, and then make the incre­men­tal steps that move us com­fort­ably yet inex­orably, forward.