Structuring the healthcare ectoplasms

The art of co-creation lies in structuring the right exchange platforms at the outset of the debate. For having forgotten this simple fact, the Obama administration is now in the unenviable position of having to extract  common themes across five different bills generated by five different committees, and trying to cajole enough senators and house representatives into rallying around some kind of consensus bill still to be developed. The administration’s challenge is now to hang five ectoplasms on a common skeleton it still has to anatomically define, and get the ectoplasms not to slime in the process.

Imagine if eBay had had the great insight that there are lots of people with stuff in their attic they want to sell, and buyers who want to buy it, but had somehow forgotten to structure the market in categories such as cars, computers, or– my personal favorite  — “dolls and bears”. Imagine also what would have happened if eBay had forgotten to establish rules for its bidding system, including how long an item is put up for auction, how buyers and sellers establish or judge each other’s credibility through a rating system, how buyers and sellers can communicate and how the commissions get levied by eBay on both buyer and seller. If eBay had just said: “go out and co-create”, we’d have a real mess. That’s the healthcare debate so far.

Co-creation is not a free-for-all. It is an organized way of engaging different parties in a different kind of dialogue by structuring new platforms that create transparency between the various points of view. As a result, the process enables a better optimization than would have been possible under the old, non-transparent system. Absent this structuring, the healthcare debate has naturally reverted back to frozen, partisan characterizations of the other camp,  as either bleeding heart liberals or insensitive capitalists, not to mention absurd slogans such as “not letting anyone come between you and your doctors” – as if insurance companies were not already there!

As Business Week pointed out in its August 6 issue, health insurers have stepped into the breach and structured the debate on behalf of the administration. Not only have they framed the platforms, but they have used their considerable lobbying firepower to present actuarial evidence in favor of their proposed solutions. In a debate between free-form, idealistic regulators wishing for a better world and business legionnaires armed with scores of data, who do we think is going to prevail in the end?

Out of this mess, perhaps a new policy-setting process will arise in Washington, where regulators view themselves not as partisan advocates of a point of view they try to impose on others, but as architects and implementers of a new democratic process where issues are framed along citizen-centric lines. When regulators learn to design debate platforms rather than a priori outcomes, a new form of democracy will emerge.

In the meantime, it’s back to chasing ectoplasms. Whom you gonna call? Ghost busters.