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Endangered species in IT and advertising

September 18, 2009

Yesterday, I spent the morning with IT people at a large European multinational, and the afternoon with some advertising people at a Top 5 global advertising agency. Both groups were attempting to work with their clients – internal for the IT group, external for the advertising agency. Both were struggling. The IT group had set up a whole intermediate function to connect the nerds from IT with the suits from the business. Of course, this group had credibility with neither side, but was trying very hard to earn it by showing they could elicit specifications from users with exquisite precision. The word “specs” is a tip-off that co-creation will be an uphill battle.

With advertising folks, the agency had established not one, but two layers of intermediaries between the client who actually wanted to develop a campaign and the creative people who would eventually design it. One layer was the account manager, while the other was what agencies call “planners” – people meant to represent the client’s point of view inside the agency – as if the client couldn’t do that themselves more effectively. Both exist to help develop “the brief.” The word “brief” in advertising is a surefire signal that co-creation is not wanted there.
At both workshops, I asked why the producers of code and creative advertising material could not engage directly with business people. I learned how fragile both populations were, and why they had to be protected from predator clients who had the audacity to believe they might contribute directly to the process, if it were made transparent to them. “We had an application guy on-site once” an IT senior manager told me, “and he nearly resigned because the client kept wanting to change the specifications.” Recoiling the horror of it all, he added: “Apparently, the client loved it, though. And it was done very fast.”
The account manager in advertising was dishearteningly honest. “If the creative people spoke directly with the client, what would be my job?”, he asked. One could see he was trying very hard. “My job is to simplify the number of ideas, bring it down to one or two, and brief the designers.” He could see he was perceived as a bit defensive. “Well, my job is also to elicit the passion of our designers. They have to be highly enthusiastic about what they present.” I suggested the executives who were footing the bill might also be looking for a chance to express their passion during that process. Wouldn’t their sense of engagement be as important as the designers’? I even suggested maybe some graphic artists could draw live sketches or concepts as executives were devising possible elements of positioning. By now, my advertising account manager looked ready to cry.
Of course, I’ve had many chances to ask actual IT developers and creative advertising people whether they’d like being exposed directly to their clients. The vast majority of them would jump at the opportunity. The endangered species may not be the animals after all, but the zookeepers.

Co-creation as cost reduction

September 13, 2009

Co-creation is getting other people to do the work and love you for it. While most people think of co-creation as a way to innovate and change the competitive rules, it is also a way of cutting cost. Why is Apple so profitable? Among other reasons because it gets its customers to market to each other. If my friends sell me on the latest Black Eyed Peas release by sharing their play list with me on iTunes, Apple doesn’t have to spend marketing dollars to promote it to me. And by the way, my friends love selling me on this new release because it allows them to show how far ahead of me they are in their understanding of latest trends in rock music. Why is IBM able to reduce its R&D cost? By setting up “collaboratories” where its partners not only bring their expertise in specific domains, but also underwrite some of the cost of that research. Not only do these partners do what would have been IBM’s work in the past, but they also see unique value in engaging IBM in a proprietary development from which they will benefit.

Many companies are in retrenchment mode in this down-cycle. In their renewed attention to cost, they are reverting to the quality and re-engineering paradigm of the last century, attempting to take cost out by streamlining business processes, shortening cycle times, or implementing enterprise resourse planning software packages. While this approach is helpful to create a performance baseline, the traditional efficiency reserves in most organizations have been tapped out. Most of these companies will die completely healed.

A more fruitful avenue is co-creation. In general, organizations bite off more than they can chew. They think of themselves as having to control and optimize a wider set of one-sided processes than is necessary. They want to single-handedly deliver predictable outputs from those processes using only company resources, failing to recognize that people at the receiving end of those processes no longer want to be passive, but want to engage in the design of the process and the co-creation of their experience. And they’re willing to do the work required to get there, therefore allowing companies to externalize some of that cost. The cost saving opportunity lies in letting go.

The two areas best known for co-creation are at the two extremes of the value chain: in customer-facing processes (like Apple) and in the product or service development area (like IBM). We routinely see companies able to cut their marketing, advertising, sales, or customer service costs by 30% or more by involving customers in the design and delivery of those processes. We witness the same order-of-magnitude improvement when companies engage third-parties in their product and service development processes.

Ultimately, though, the greatest gain lies in applying the principles of co-creation inside the company. Individual functions inside a company suffer from the same evil as the company as a whole. They try to do too much on their own, attempting to create value by defining themselves as “process owners” responsible for delivering a repeated and predictable output to their “process customers,” typically another function in the firm. Whenever sourcing views manufacturing as its client rather than as a co-creation partner, it inevitably generates too much cost for itself and for manufacturing, and destroys some experience value for both. The same is true when an actuary in an insurance company views marketing as its client, when a chemist formulates a product “for” marketing, or when the Human Resources department views the management team as its client for coaching services. Most cost to be “engineered out” lies at the intersection between company functions.

Eliminating this cost requires setting up platforms that engage both parties in a dialogue where the processes on both sides are made transparent, enabling a new dialogue between them and leading to the development of new experiences beneficial to both parties at a fraction of the cost. Unlike in the old re-engineering and quality paradigm, these platforms do not attempt to create a deterministic process that optimizes the flow of goods and information between functions based on some perceived need. Instead, they enable faster, more contextual decisions that dramatically reduce cost and improve cycle time by tapping creativity on both sides in continuous fashion. These platforms sometimes require some form of information technology investment, but they often involve a simple reconfiguration of basic day-to-day interactions between people.

In that sense, co-creation is the new frontier of productivity.

Co-creation is eternal

September 10, 2009

On September 11, 2001, I lost two of my colleagues and friends on the first flight that hit the World Trade Center towers. The memories of the day are still raw eight years later — I keep a photo of these guys on my desk at home to give myself the will to fight every day. But rather than focus on the sadness, let me highlight the redemptive power that came from the community they helped us build around them.

It started close to home. My friend David Norton, of Balanced Scorecard fame, came to see us as soon as he heard in the morning that two of our guys were in the first plane that crashed on the Towers. Several times during the day, he visited our conference room, as we were trying to find out information from the American Airlines emergency call center and relay it to the two wives of our colleagues. Dave is not the exuberant type, but seeing him there provided a strongly reassuring presence. I particularly remember the deeply egalitarian nature of human suffering, which brought everybody together at that moment, from simple front-desk people to world-class scholars. Toward 7 pm, American Airlines told us there was no hope left. No more need to look stoic and resourceful. We all broke down and cried.

While the emotional burden felt heavy, it was nothing compared to what the families of the victims were going through. I remember this time as one of extraordinary clarity of purpose. My role was not to show compassion, but to provide support: help the widows and their children financially, provide support mechanisms for the surviving employees of the firm, and figure out how to survive economically as a firm in spite of the human losses. Undoubtedly to make me feel better, people undeservedly kept praising me for my focus in managing our little ship through the storm. But what else is there to managing a ship in a storm than try to survive it?

We discovered we had famous friends. The widow of one of the victims sang for the Tanglewood Festival Chorus, chorus of the Boston Symphony Orchestra. The entire group came and sang at the memorial service. Warner Music — the company for whom my two colleagues were working on that fateful day — not only sent superb artists for the service, but gave us another project to make sure our little firm would continue to exist in spite of losing two of its key people. Ted Kennedy — who passed away recently — intervened to allow one of the two victims to be recognized as the father of the child he and his wive were in the process of adopting — the first time in Massachusetts a child was adopted by a deceased father.

We also learned we had a lot of other, regular friends. The downstairs cafeteria in our building had a particularly gruff employee –nicknamed the “soup Nazi” after the Seinfeld episode. When he handed me my food a couple of days after the attack, he had a tear in his eye. The landlord in our building erected two flag posts in memory of our two fallen comrades, one at each end, and both flags still proudly fly today at that building. We received e-mails and cards from friends we never knew, simply because people all over the world were touched by the story of what happened to our little firm. The memory of our two guys still lives at the new firm we have created since then. Two members of our current firm were close to one of the victims, and although we rarely speak about it, we know the memory of our fallen friend binds us powerfully.

So tomorrow, I will not be sad. I will celebrate the community that these two people built for us. Through this community, they still live with us. Co-creation is eternal.

Pro-creation vs. co-creation

September 5, 2009

When I first mention the term co-creation in a class or conference, at least one member of the audience, anywhere in the world, starts riffing on co-creation vs. pro-creation (the quasi-homonymy also works in other languages than English). This unavoidably triggers libido rushes in the group, accompanied by more or less graphic sexual images. I pretend I’ve never heard it before and we move on. Now, I know my audience is loose and engaged.

Prompted by this repeated early exchange, though, I started thinking of the actual similarities between co-creation and pro-creation. There are indeed some. First, you have to be in the mood. Yes, there are techniques of co-creation one can learn. (I’m thinking of publishing these under the title of the Kama-Sutra of Co-Creation). The book will offer a re-interpretation of some analytical tools such as “interaction maps” and “X maps”. I figure the “DART model” will be popular with men, while women may prefer “experience curves”. But none of these techniques amount to much without the desire of the two parties to co-create.

Second, there has to be a place for both co-creation and pro-creation to occur, an interaction platform of sorts. It doesn’t have to be the back of a car or behind a hay stack, but there needs to be a location where two or more people can have access to each other for an intimate dialogue in full transparency. Interaction platforms for both pro-creation and co-creation can be virtual, including web sites of various kinds, possibly supplemented by other more mechanical technologies. We encourage the use of videos to understand the true experience of the other party. Simulations can also play a role. Coaching is helpful. We also highly recommend community involvement because group activities add a new dimension to both co-creation and pro-creation.

Third, you have to be, huh, able. There is some plumbing involved, and if the plumbing does not work, there won’t be any co-creation or pro-creation. I’m afraid there’s no Viagra for co-creation (if there were, this is the business I’d be in, not this miserable teaching and consulting career). So your only chance is to get your body in shape through practice. Practice early and often. Keep the thought in your mind all day long.

At some point, I’ll have to let go of this parallel between co-creation and pro-creation. Under normal circumstances, I would now move to principle 4, which states that you should start by co-creating inside your organization before attempting to co-create outside. But my legal department advises me this could be narrowly interpreted as an encouragement to have sex at the office or sleep with customers, both of which are really bad ideas, so please scratch principle 4 from the list.

Overall, though, I must admit I was wrong. Co-creation and pro-creation are like twinnies.

The conversion of experts

September 4, 2009

I cannot help but be attracted to experts: actuaries, biologists, chemists, nuclear physicists, software architects, fashion designers. I love them all: the nerdier, the better. First, there’s the sheer joy of discovering their vocation and talent. These guys love their jobs and they’re good at it. Have you ever observed a designer free-hand a sketch just because he’s bored at a corporate meeting? Or a statistician looking at a plot slowly taking shape on a computer screen? This is the wonder of business creation. Second, there’s the pleasure of the anthropological discovery of species that are new to me. Not everybody gets to interact with an actuary in his natural habitat inside a large insurance company tower.

My real purpose, though, lies in exposing them to the world. For I don’t simply want to observe them in their corporate quarters. I want the walls around them to come tumbling down, revealing to the world how great minds manufacture hits in their studio. I want to make their labs into remote stages and get them to become inadvertent stars in live public performances.

At the beginning, they look at me funny. Actually, some of them don’t even look at me, like actuaries (the introverted actuary looks at his shoes, the extroverted one looks at the other guy’s shoes, as the joke has it). “You wanna do what? Take me to some agents and customers? Do you actually understand what actuarial science is? It’s about numbers, dude. Nothing to do with customers.”

The trick is to get them to explain what they do in layman’s terms, so that ordinary people can understand their craft and connect it to their experience. The whole idea is to blur the line between what they do and what the customer does, since the goal is co-creation. Of course, I’m the first test case. Most of the time, I don’t have a clue, which makes me the perfect foil for the “tell me how you cook” line of questioning. I’ve discovered the perfect word to use with experts is “vulgarize.” This puts them at ease, granting them the respect they deserve while allowing some slight sense of condescension toward lesser educated beings.

The trick for experts is to let go, to move from bottler of science to broker of knowledge. It’s not easy to let go. The lab is more comfortable than the cold stare and acerbic questioning of customers. At the first workshops, they want to lecture, preferably using equations or molecular representations. I try to get them to pause and think through: “if a customer were there listening to you, what questions would you like to ask him?” They look baffled and annoyed, then slowly start formulating questions. From one workshop to the next, some of them get really good at it. A Franco-German chemist recently developed such a wonderful story that he could get farmers on four continents engaged in co-designing the formulation of the next product with him as if they were PhD chemists themselves.

The best moments come in the bus or the plane on the way back from those workshops, often in remote parts of the world. Occasionally, one of those experts comes to me and says: “I have changed the way I think of my job.” And just like that, it all becomes worthwhile.

Do the French have a word for “entrepreneur”?

September 3, 2009


President George W. Bush reputedly told Tony Blair one day that “the French don’t even have a word for entrepreneur.” Not only was he etymologically confused, he may have been downright wrong. The French have created a lot of successful global businesses over the last 40 years, although these businesses do not fit the classic Anglo-Saxon entrepreneurial model. The French believe in the power of government funding to launch and sustain global enterprises. As a French-born, University of Chicago-educated boy, this success has generated a personal schizophrenia between the natural interventionism of my origin and the laissez-faire convictions acquired from my alma mater. As a result, I have slept badly for most of my adult life. 

In the grand, centrally controlled tradition of Napoleon, French political leaders believe state governments can and should play a role in business. In fact, Jacques Attali, an influential advisor to most recent Presidents of France, from the socialist François Mitterand to the conservative Nicolas Sarkozy, advocates that France’s competitive advantage over the last 40 years has been its ability to centrally fund major infrastructural developments. Success stories have included Airbus, the French-led, European consortium of aircraft manufacturers taking on Boeing in civil aviation; the French national utility EDF establishing a strong global position in nuclear energy; and the national railroad company SNCF and its supplier Alsthom jointly learning to build and operate TGVs, the French high-speed train. To add insult to injury, Attali contends that the U.S. has begun a gradual decline because of its capitalistic excesses – “similar to the Roman empire in its decadent phase”, he adds for good measure – pointing out that the center of the economic world is now leaving the U.S. to continue its eastward shift toward China. 

It is difficult to argue that the U.S. free market model is thriving, particularly at a time where the U.S. economic policy under the Obama administration has become vastly interventionist to support banks and automotive companies, and is trying to establish a government healthcare mandate. It is equally hard to deny that the stock of China is rising compared to the U.S. So maybe we let the French win this one for now and grant that they indeed have a word for “entrepreneur,” which is “l’état entrepreneur.”

The ultimate economic model, though, remains to be crafted. There is an undeniable global appetite for tightening the social compact between citizens, including in the more traditionally free-for-all U.S. market. At the same time, government organizations still suffer from relative inefficiency, including at Airbus, SNCF and EDF. The future may lie in a new form of technology-enabled, bottom-up democracy where politicians co-create the economic agenda with their citizens. We have seen evidence of co-creation seeping slowly into politics, with the campaigns of Howard Dean and Barack Obama in the U.S. (and some Republicans rapidly catching up), and the presidential campaign of Ségolène Royal in France (and more recently Nicolas Sarkozy). The Hong Kong administration and the government of Andhra Pradesh in India have offered advance glimpses of this future, technology-rich form of government, where the social contract is built piece-by-piece by citizens at the local level, rather than mandated from the top, fostering a more efficient use of resources and preventing the excesses of raw capitalism. We should encourage citizens to build this economic agenda with their local businesses. There is already a powerful local food trend. Why not a strong local business trend? 

Only then – when co-creation of the economic agenda by citizens at the local level becomes the “third way”– will I get to sleep, finally at peace in this Franco-American reconciliation of economic models.

A brief history of co-creation

September 1, 2009

Einstein reputedly said, “The secret to creativity is knowing how to hide your sources.” The same can be said for co-creation. The word “co-creation,” at least in its popular, limited definition, is associated with a decidedly modern view of how customers can engage differently with companies, often by building social communities mediated by some form of technology. We think of eBay, Apple, Facebook, and Twitter. But co-creation was arguably born much earlier, in the 19th century on the French countryside, to be precise.

You will have to excuse me. I’ve been in France for more than a week, and if you stay long enough, the French will try to convince you they have been first at everything, from inventing the bicycle to flying the first airplane (come on now, we all know Americans did those things). When it comes to co-creation, though, the French may have a point. The start-up of the French bank Credit Agricole at the end of the 19th century, for example, was arguably co-creation in action. A bunch of local farmers in the French provinces did not have enough of a regular cash flow to warrant the attention of banks (crops have a way of getting wiped out by weather or pests), so they decided to lend money to each other. It was an eBay of sorts, with money being the merchandise exchanged for a fee. The rating system of lenders and borrowers was a transparent one, where drinking guaranteed the farmer immediate rejection when applying for a loan. This “too much wine, no money” edict may not have been as sophisticated as the modern-day consumer credit algorithms, but it did allow all these local farmer co-ops to grow and enabled Credit Agricole to federate itself into one of the largest global banks.

The French also claim they invented mutual insurance – another instantiation of co-creation – In the 1930s. The most legendary of the mutual insurance firms in France, MAIF (French people love acronyms that puzzle foreigners), was started by high school teachers. These guys drove slowly and washed their cars every Sunday. They’d also seen those farmers organize a bank, so they figured they might as well organize an insurance company since the bank idea was already taken. MAIF had fewer losses than the other segment of French population called the non-high school teachers, and it grew rapidly. At some point, MAIF figured it could invite descendants of high school teachers to join in, on the assumption that even though they had lapsed by not becoming teachers themselves, maybe enough good genes had remained. And so the French invented co-creation, first in banks, then in insurance.

Some skeptics point out that wine growers on the banks of the Rhine in Germany were doing exactly the same thing at roughly the same time, creating a German version of Credit Agricole called Raiffeisenbank, also a very large bank today. I will refrain from mentioning more because there have been enough difficulties between those two countries already without igniting a war over co-creation (although the unabashed promoter of co-creation in me thinks it would have great marketing potential).

Since then, some of my Mexican and Brazilian friends have argued that Latin America invented co-creation long before anybody else, initiating the concept of community lending or tanda (related to the French word tontine, which the French use as etymological proof that they were there before the Latin Americans, since they gave them the word in the first place). And the popularity of micro-credit in Asia has prompted some Indian scholars to research the early appearance of group lending in rural villages in Asia, showing that it predates the appearance of co-creation on all other continents.

So maybe co-creation was not invented by the French after all. Perhaps the concept was, well, uh, “co-created.”

Wikipedia comes of age

August 26, 2009

For a while, I stopped using Wikipedia as an example of co-creation. I had long taught it as a simple, well-known case of how content can be cheaply and quickly developed by users, producing a disruptive model for dictionary and encyclopedia publishers. Everybody knew Wikipedia, from the jungles of Brazil to the remote islands of Indonesia. Each workshop was an opportunity to discover that few people write in Wikipedia, but many read it, because they trust that those who write in it know what they’re talking about.

Then things turned ugly. Wherever I’d be teaching, someone would point to the latest manipulation. The most recent is by a young Irish student who manufactured a quote in Wikipedia about Maurice Jarre, the French composer, upon his death in May of this year. I cannot resist giving you the quote, since it is as wonderful as it is fake: “One could say my life itself has been one long soundtrack. Music was my life, music brought me to life, and music is how I will be remembered long after I leave this life. When I die there will be a final waltz playing in my head, that only I can hear.” Although it was listed with no source, the quote was picked up by many papers around the world, including the prestigious Guardian of London.

I had another incident in Chicago three years ago. As I mentioned Wikipedia, a bunch of young guys in the front row started giggling. It turns out they’d been watching Stephen Colbert, the American comedian and talk-show host, brilliantly make fun of Wikipedia the night before (why were these guys not working on their assignment anyway?). In particular, Colbert had just coined the term “Wikiality” to describe the creation of “a reality we can all agree on.” It’s not easy to re-establish your professorial authority when you’re up against Colbert.

In particular bad taste were the attempts by some in Wikipedia to describe Senator Ted Kennedy as dead when he was still alive (I just learned at breakfast this morning in Paris that he passed away last night).

The solution for Wikipedia turns out to be a simple one. Remembering that co-creation does not mean abdication on the company’s side, the Wikipedia board just announced that it will anoint editors who’ll check entries made about living people. Wikipedia people are up in arms about the perceived sell-out, but from where I sit, there’s nothing wrong with injecting a little control in your co-creation. After all, the “co” in co-creation stands for both company and community.

With this new policy in place, I may even go back to uttering the W word in public.

Drew Carey plays better soccer than David Beckham

August 21, 2009

As a diehard soccer fan who’s lived in the US for more than thirty years, I’ve been frustrated by the futile attempts of professional soccer leagues to establish the sport by hiring aging European or Latin American stars. When the LA Galaxy recruited David Beckham two seasons ago, I thought this was another example of a major league team not understanding that they should be co-creating a fan experience around the team, not packaging a product. Beckham has lived up to my nihilistic expectations by being injured most of his first season with the Galaxy, then in the second season treating his Galaxy commitment as summer recreation compared to his more serious AC Milan engagement. He was recently taken to task for his tourist-like behavior by Landon Donovan, a lightning-fast teammate at the Galaxy (the two have reputedly made up since then). Some Galaxy fans have booed Beckham during home games, producing startled comments by journalists that fans would care enough about soccer to go to that trouble…
I have nothing against David Beckham the person. He seems a nice enough chap and was a great soccer player. But I strongly object to David Beckham the brand when that is considered the future of US soccer. To discover a more authentic model, I suggest going a thousand miles north to see what the Seattle Sounders have been able to accomplish. A recent article in the Boston Globe describes how the team, in its very first season, draws more than 30,000 people on average for home games, doing better than the long-established Seattle Mariners baseball team and doubling the average attendance for Major League Soccer games.
The model is pure co-creation with fans. Fans picked the name of the team. They came up with the concept of a colorful march to the stadium behind drums before every game. Season-ticket holders get to sit with like-minded fans, i.e., they choose to be in a section where people cheer loudly or conversely want a less exuberant experience. Fans get to oust the general manager every four years, a governance structure copied from FC Barcelona and Real Madrid – although Seattle fans do not get to elect the new one like in Spain (instead, the owners do). Speaking of owners, the Sounders have come up with a uniquely American “mixed model” of ownership. The team has four traditional “rich guy” owners – including the actor Drew Carey, who is credited with coming up with the fan-centric model after a trip to Spain, a Hollywood producer, and the ubiquitous Paul Allen – but their influence is leavened by the fans’ participation. Somehow, this enlightened team of owners has figured out that engaging the fans is the way to go.
While the success of the Seattle Sounders warms my heart, it caused me to lose a bet. I figured the male-dominated Major League Soccer would never figure out the fan thing. My money was always on US women’s soccer to invent the new model. I hope the new women’s soccer league in the US gets to do that anyway, for the world needs a successful women’s soccer league. In the guys’ department, though, it’s Drew Carey 1, David Beckham 0.

Healthcare co-ops as co-creation

August 19, 2009

There have been so few new ideas on either the Democratic or Republican side of the political debate since the advent of the Obama administration that we should welcome the arrival of the healthcare co-op idea recently floated by the Senate Finance Committee.

Of course, the idea has already been ridiculed by politicians on both sides of the aisle, because it is neither a true public option nor a fully private-sector enterprise. But let’s remember that being mocked on both sides is often the beginning of bipartisanship. So far, co-ops have been viewed as a sort of union where consumers would come together in a nonprofit structure, negotiate with doctors and healthcare providers, and compete against traditional private-sector insurers. I can’t get too excited about this concept because it does little to reduce overall cost, which is the real issue here. Eliminating some of the costs associated with the high salaries of private-sector management and the remuneration of third-party investors is not that big a deal. Also it’s hard to see the self-replicating nature of the enterprise that would allow the co-op to rapidly reach a scale where it can compete against private insurers.

But if doctors were allowed to become part of the co-op, then the game would become interesting, because both sides would have a vested interest in lowering costs and could engage in the co-creation of unique solutions to get there. Imagine you’re a middle-aged, overweight person belonging to such a co-op and you’re facing your general practitioner for your yearly physical. Further imagine that you both are members of the same local co-op. Your motivation to lose weight increases if you know your extra pounds not only create a health risk but also impact your premium. Because the doctor is a fellow co-op member, he is no longer a dispassionate dispatcher of “I don’t care if you listen to me” advice. The doctor is now more likely to put pressure on you to shape up, since he personally suffers the financial consequences of his patient’s bad habits. Both doctor and patient now have skin (or pounds) in the game. The royal “we” in “Now, how are we going to lose weight?” becomes a true “we.” And that’s harder to ignore. In this intertwining of the doctor’s and patient’s fate lies the true opportunity to reduce costs, and the chance for the co-op to effectively compete with health insurers.

It also becomes easier to see how co-ops with joint memberships of patients and doctors could scale up rapidly. There is an eBay quality to this marketplace of buyers (patients) and sellers (doctors) coming together to organize an efficient healthcare exchange. I’ll bet you could find quite a few doctors and patients in many communities willing to put up $5,000 of capital to get a local co-op going. Before you know it, you’d have a respectable amount of capital that would allow the co-op to set up shop, buy a few computers, and hire some people. If we truly want healthcare reform, let us put our money where our mouths are. The interests of doctors and patients are objectively aligned. A few successful, early communities could trigger a rapid proliferation of the concept at the national level. If doctors became excited about co-ops, they in turn could redefine their own relationship with their hospitals and bring them to the negotiation table with the co-ops.

This democratization of healthcare through co-ops would bring healthcare back to the people who care the most about it: patients and doctors. Let’s give them a chance to shape the concept.