Author’s Notes On Plumbing

Author’s Notes On Plumbing

In the three recent blogs (for use on three sleepless nights): A Brief History of Plumbing; A Tale of Three Cities; and John’s Folly, I hope I haven’t insulted any real cities.  I intended them to all be fictitious.  I want to point out that this is not a private enterprise is good and public agencies are incompetent story.  From my perspective, the worst of the stories are in Paris with Bill the businessman.  These are intended to highlight how something as simple as sink repairs can have such dramatically different outcomes depending on how the organization imposes constraints or allows creativity.  How enabling risk taking when the consequences and the benefits are bundled together can foster a better outcome for everyone.  And just how fragile excellence can be and how many kinds of greed and arrogance can threaten it as in the case of Ernie’s success leading some to suggest that something must be wrong.

I will note that I started writing this after a discussion with a presidential candidate (not the US).  He asked me one evening how I thought he should approach reforming healthcare in his country if he was elected.  Clearly I recognized his judgment was impaired if he would even ask me and so I declined to answer him that night but the question kept hounding me. 

I might also note that when I started writing this I expected my answer to be a Managed Government plan.  Even though I had professionally grown up in a Fee-For-Service approach I believed that if healthcare is to be treated as a citizen’s right then a Fee-For-Service model is not tenable.  It was very good model if healthcare is considered a privilege but if it is considered a right that model produced perverse incentives.  It was much to my surprise to find that as I wrote this I came to the conclusion that the Balanced Risk Benefit model made more sense.  The last blog in this series was my effort to anticipate the perversions that a Balanced Risk Benefit model might spawn and they were obvious.  The good news is that the mechanism to prevent them was not only obvious but was part of the same tools that a contractor would want to allow them to execute efficiently.