Trust, Politics and US Health Care Policy

The ability to trust is not an unalloyed virtue. It opens one up to the possibilities inherent in a relationship. It can also make one scam-candy for the unscrupulous. Yet trust without risk is not trust.

So we have evolved to make snap judgments and hold them strongly, even in the face of contradictory evidence. We also extend trust, via a trusted agent, to new arenas.

Which is why it’s so hard to de-politicize big policy issues. We tend to trust one party line or another on major issues. Answers to “Do you hate Hillary’s health care proposals” are highly correlated with “Do you hate Hillary?” Thus, when it comes to complex issues, our blind ideological trust serves us badly.

What we need in such cases is a Nixon-to-China personage; someone to shake and confuse our ideologies in ways that lead us to look afresh. May I suggest Regina Herzlinger in the field of US health care policy.

Ms. Herzlinger is a Harvard Business School professor whose career focus has been on non-profit organizations—particularly health care. Her third book on the subject, Who Killed Health Care? , has just been written, and she’s interviewed in Is Health Care Making You Better; or Dead, part of the HBS Working knowledge series.

Depending on which quote you take out of context, you’ll think you’re reading either Michael Moore or Milton Friedman. Put them together in context, and you’ll think you’re reading blindingly obvious commonsense. It’s that good.

She succeeds in using the tools of capitalist analysis to create an indictment of our health care system—as a system that is bad for health and bad business at the same time. She pulls no punches, as she outlines the chillingly bad-business practices of the five health care “killers” (her term); health insurers, the US Congress, employers, hospitals and academics. (Pharma catches a break finally).

Another Nixon-to-China component of Regi’s approach is that she demonizes very few individual human beings; in fact, she clearly respects the devotion of many in all five “killer” systems. Yet this doesn’t detract from her indictment of the system. She also offers specific suggestions which, unlike Michael Moore, are quite hard to label as one or another ideological –ism.

I’ve never understood why Regi Herzlinger’s health care work hasn’t gotten the attention that went to, say, Michael Porter or Ira Magaziner. Perhaps it’s because they were easily classifiable into trust-proxy ideologies; she is not.

Joseph Califano, after the Clintons’ ignoble shot at health care in the 90s, said that health care reform wouldn’t come until after campaign finance reform, because of the same power-sustaining characteristics that Herzlinger points out. Perhaps her health care work may actually contribute to campaign finance reform, the new Supremes notwithstanding.

Sometimes our trusting instincts get complacent, and we need someone like Herzlinger to shake them up.

Full disclosure: Herzlinger was a professor of mine, I’m very proud to say.