Reform

There is a lot of energy around health care and immigration reform these days. At the rate of health care cost escalation, it is reported that the average family will pay about $38,000 a year for insurance just nine years from today. Although our health care system is very complex and involves many organizations at numerous levels, there is very clear evidence that certain players are making choices that contribute to this problem. We have had this information in health care for nearly 20 years since Dr. Jack Wennberg found that the high hysterectomy rate in Lewiston, Maine was the result of the doctors' choices rather than true indications of need.

The usual cast of characters performs here: doctors out to make money by providing care and performing surgeries, HMOs out to make money by reducing the amount of service and surgeries in order to retain capital, prescription companies advertising directly to patients in order to make money, patients out to get what they want (not always what they need), malpractice attorneys out to make money on patient dissatisfaction (not always malpractice), hospitals that offer state-of-the-art facilities at astronomical rates that can drain nearly any person's personal wealth in the last few days of life when other far less costly alternatives exist, etc. The list goes on and on. Each player has some rationale for how and why it plays the game. For some, it seems apparent that they are just trying to make it through life playing by the rules and hoping for the best. But there are clearly those who are exploiting the system and reaping billions in the process.

Getting angry about the situation doesn't seem to make much difference. We drifted into this position over time; and with the help of everyone - the good and the bad. A country doesn't end up #1 in high tech facilities and #49 in infant mortality without some real effort. Cuba has a lower infant mortality rate than the U.S.  These statistics are all over the place and we hear about them on a regular basis, but not much changes as a result.

We can see much the same story unfold around the issue of immigration although some of the players are different. The way the story is generally told, "the villains are poor people who sneak across the border to steal American jobs; there are farmers and growers willing to hire them under the table; there are politicians who are not willing to hold a hard line because they want to get re-elected; and there are people like us who buy the fresh fruits and vegetables at very reasonable prices."

So, the story goes on, "...that even if the migrants are not here to steal jobs (since most Americans would not do that work for such low wages) they are still unfairly burdening our health care system and our schools. The fact that they must bring their children and that they are hundreds of miles, if not thousands, from their communities and possible healthcare is of no concern to us. That is their problem."

Just last evening I was talking with a friend from the San Diego, California area. This is a very good and caring person, and I have no doubt that her intentions were good. Her position was that migrants should come over legally and take their money back to Mexico at the end of the day or week or whatever. She said that she pays migrants to do work for her. She doesn't take out taxes or anything, which she believes is okay since she doesn't expect them to get anything else from the U.S. system (Although that is not legal and is not her choice to make.) She said that the money they make here will allow them to live at a much higher standard in their home country. And, with that, she feels that she is neither participating in the exploitation of migrant workers nor undermining the U.S. system of tax laws. Her argument and behavior are not really irrational, but it is narrow in its focus and illegal in its application. What about those who must travel so far that they cannot return home at the end of the day?

It is not my intention to delve deeply into health care or immigration/migration. Each is far too complex for this blog. I am, however, suggesting that we look in other places for the solutions. Regardless of the final form of the current governmental health care reform efforts, it is doubtful that the pharmaceutical corporations, hospital groups, American Medical Association, American Chiropractic Association, American Osteopathic Organization, individual doctors, and patients will change in a substantive way. They will probably all feel the consequences of the bill and complain about how it affects them negatively. Certain surface features of our health care system might get moved around, but the deep issues will remain. They will remain because they will not be considered. They will remain for the same reasons that we are obese, that we smoke and drink too much alcohol, that we don't exercise enough etc. - because it is too damn hard. For some it will be financially and politically risky as well.

It's not too hard because we can't stop overeating or smoking or drinking. It's not that we can't find time for exercise on an individual basis here and there. There are certainly personal challenges that pose difficulties for us, but another major issue is that we don't know how to make it work as a system. We have become increasingly isolated from a sense of community and, therefore, lose the power and support that used to come from it. Such support is called social capital. Robert Putnam's best-selling book, Bowling Alone, provides a deep exploration of that concept and how we have changed as a nation over the past decades. The Nature of Health by Michael Fine and James Peters, discusses how we might manage and enhance our community health by doing things differently.

In Dirty Rotten Strategies, Mitroff and Silvers discuss how we often fail to identify the real problem, either through ignorance (a Type three error) or intentional misdirection for a narrow, self-interested gain (a Type four error). This failure often comes from not including enough perspectives from various members and groups within the system. Mitroff and Silvers argue that problems only exist within systems. For example, the fact that you have no money is not a problem unless you are part of a social system where money has value, and you need it in order to keep a roof over your head. If you lived alone in the wilderness, having no money would not be a problem - keeping a roof over your head, however, would still be a need. Identifying the real problem is critical. Recognizing that its solution lies within the system is also critical to the long-term solution.

Technology has allowed us to live independently of others in many ways. We can telecommute thousands of miles so that those with whom we work never actually see us outside of an image on an LCD monitor. The Internet provides access to so much information that one can almost diagnose physical problems without medical training, fix a plumbing leak, remodel an entire kitchen, drive from place to place with turn-by-turn instructions via wireless GPS systems.

The list of ways that we can disconnect from others is huge - and growing. We become isolated and yet we work as members of teams. We become deluded into thinking that we can exists as individuals in more ways than is really possible. We forget that we can take money out of a system and live apart from it in large part only as long as the system exists. We have people living in gated communities that keep out the "other people." We can actually forget all about the "other people" when we are at home. And yet, they are necessary for the system to work as it does such that the gated communities can exist in the first place.

We live in denial that the "other people" are necessary for our gated-community lives - or we don't care. As people move toward the top of our social system, they are increasingly protected from the difficulties inherent in the system. In fact, many of those difficulties are created by them as they pursue financial gain. As we sit in our comfort, we can talk about philanthropy and pontificate about how others might live differently. But rarely do we move to a position where we can experience even a moment of those "other peoples'" lives, especially the hopelessness that things will ever get much better.

The solution seems to be dialogue and communication within and between individuals and communities. In addition to providing new ways of seeing things, they build awareness and can create accountability. When I make commitments to others, especially face to face, I am much more likely to follow through. When I am in community on a regular basis, that commitment is there in front of me, and my performance is known to others. Accountability adds energy to my commitments. It keeps me focused. The transparency that allows others to see whether I am being accountable or not adds power to the overall system.

The problem with this, of course, is that a system with this level of openness reduces the opportunities for individuals or companies to take advantage of others as they build their fortunes. Our capitalist system in the U.S. is predicated on the individual and entrepreneurism. It is not a gentle society that strives for peace and harmony for everyone. Our system is fraught with fits and starts when it comes to any meaningful change. Relative to large, systems changes, most of the real change has come through some form of revolution - unions, civil rights, equal rights, women's rights. All of these movements required real sacrifice and risk of life and limb.

I am neither endorsing revolution nor movement away from capitalism. Consolidation of resources, and other forms of wealth, is an historic process that seems to be closer to the natural order of things than the social concepts of distributed wealth, sharing and true concern for others. I am, however, wondering what it will take to see real change occur relative to our current health care system. Occasionally we are reminded of the systems nature of our government as the news reports how concessions were made by one side in order to get something from the other side. Usually, it is framed as a negative event where the one is "held hostage" by the other. In reality, at least in the U.S, it is.  Life, however, is full of compromises as millions of individuals attempt to live and work together in order to experience a "better" existence.

Becoming aware of and openly discussing these complexities and necessary trade-offs might reduce our cynicism about the possibilities for change. Talk may be cheap, but it is not necessarily easy. The zero-sum process of debate is so dominant in our society, that we have little skill with other forms of communication. We don't have much experience sitting with the anxiety and uncertainty the comes with suspending our judgment of what the other person is saying. We usually want to get away from those feelings ASAP by bombing the other side with our facts. Although polarizing people into two big groups with one on each side of the issue, a lot gets lost. We get caught up in arguing about ideas instead of purposes.

Regardless of what happens on the grand national scale, we can begin to talk together in our families, neighborhoods, and communities. The good that is generated there can be a seed for the next level.

Resistance is futile

How many times do we hear ourselves, and others, say things like, "I'm really going to change the way I do things at work." I was talking with someone the other day who was commenting on his iterative process of failure. It seemed that no matter what plan he put into place, he found himself doing the same unproductive things with his time. As we talked about it, he made a funny face and, using a voice that simulated an alien from a sci fi movie, said, "Get used to being a dolt. Stop trying to change. Resistance is futile."

He thought back (not too far back) on things that he had tried to change and said, "If I approach things from the perspective of resisting the temptation to fall into the old habit, I usually fail. There might be a brief period of success, but failure is tenacious. It has all the time in the world to wait for me to get tired of resisting, or to forget about it. Either way, I eventually lose. Resistance is futile."

I asked him if he ever succeeded. He said that he has won at times; and that the recipe is always simple. Getting the ingredients together, however, is the more difficult part. Actually, there is only one ingredient - commitment. Some might argue that one makes a 'commitment' to resist during those brief periods of success. But that is not what I mean by commitment. I am not talking about committing to change. I am talking about committing to a different way of being. In that new way of being, there is nothing to resist. The option of engaging the old ways does not exist in the same way. When the commitment is clear, the insufficiencies of the old ways seem so glaring that there is no longer any temptation.

If, on the other hand, the commitment is to resist the temptation of the old ways, when one succeeds in resisting, one is left with more of the same. Each successful resistance leads to the opportunity to resist the next time. What kind of life is that where the focus is on resistance? This perspective focuses on "the problem" and our resistance to it. That way of thinking, however, has the potential for creating a problem-focused way of living. We are always moving away from something.

Taking an appreciative approach to life puts our desired future as something we are moving toward. It is based on our past successes, so we can be encouraged that it is possible. The focus of our past success is not just any old success, but one that rated as a big one - a peak experience.

There are a number of books written on this process called "appreciative inquiry." It grew out of the work of David Cooperrider at Case Western Reserve University and has influenced a wide range of professional areas like organizational change, coaching, and personal development. One of the books I found helpful for guiding personal growth is Appreciative Coaching.

If you want to go right to the source, get Cooperrider's book. Either one will help you see things differently so that your commitments to change might be more easily made and maintained.

I'm almost ready...

I can't even begin to count the times I have said, "I'm almost ready to..." I was really almost ready after reading Neil Fiore's book on procrastination called The Now Habit. For me, however, almost ready has become a steady state. It is my homeostasis. I am delicately balanced between doing something and doing nothing. I keep my life teetering in a space where not much is happening BUT it could at any moment IF I could just take the important step.

I don't have any problem at all coming up with the big ideas. In fact, I am plagued by them. I don't have much problem taking off with them as I dig into their potential. I wander around thinking and writing about them. I collect information and consider the "what ifs" that might occur if I put them into action. I do all this stuff...for a loooooooooong time.

I have been frustrated by this most of my life. One would think that eventually I would catch on. But, as the crazy Saturday Night Live comedian, John Belushi, used to say, "But, noooOOOOOOooooooo," I haven't. I have periods of time when I think I have a handle on things, and then it's gone. Here is the cascade as it has unfolded so far: Seven or 8 years ago I realized that I have often been frustrated by being unprepared for projects or presentations. There were very few times when I failed to spend a lot of time getting ready. But when game time rolled around, I was ill-prepared. What frustration!

I remember a time when I was getting ready to run a 12-hour seminar. My friend asked me if I was ready. I told him that I was - that I had over 400 slides prepared. He looked at me with that look that people use when they are questioning your sanity; and asked if I had considered how many slides I would have to show per minute in order to get through them all in 12 hours. I hadn't thought of that. (It was just over 1.5 slides per minute - for 12 hours!) I had accumulated a lot of material but hadn't really thought about the execution. Needless to say, I pared the slides down considerably.

Sometime later, I had an insight that my failure to prepare came as a result of my lack of focus. I was not concentrating my efforts on the topic effectively. Instead, I was putting all kinds of interesting stuff into the mix that was not really necessary. I needed to hone my attention down to something manageable. I was excited to come to that realization. But it didn't change as much of my behavior as I had hoped. I had developed procrastination in order to avoid the feeling of overwhelm that came with seeing a project with no focus. Nearly everything seemed relevant.

Time moved on...I began to ask myself why I was not yet effective now that I knew that focus is important. The next layer was revealed: I needed clarity on my goal. Focus required a focal point. As an intuitive person, I generally fail to recognize that my big idea needs a nucleus. There is a nucleus, of course, I just don't see it. So, now I had awareness that clarity was critical. I had experience with being clear on my objective. I would jump in and work like crazy fueled by my accomplishment as I moved toward a well-defined goal.

More time...Clarity wasn't coming. I had awareness of it and desire for it, but it eluded me. I kept wondering about how I would peel back this layer. Certain areas in my life were more active. There was energy and I was once again writing and thinking, and I was taking small action steps. I continued to feel that the next level in my life was just beyond a thin veil right in front of me.

Where was the clarity?...As I pondered how I would see things in a better light, the question emerged, "clarity about what?" I realized that I was not really committed to many things. I began to wonder how I could be clear about anything when I did not make a commitment to its importance in my life. I didn't need to marry the issue, but I did need to recognize that I had to decide that it was important enough to devote time to it as I put other things on the back burner, or off the stove entirely. But, that still didn't make much difference. I needed to find a reason to make a commitment.

Now what?...I realized that value was important to commitment, but I didn't have a way to energize my values. I needed passion. I had done a lot of personal reflection. I had used any number of exercises recommended by books and articles in addition to processes that I dreamed up. I knew the things that seemed important to me, but they seemed like these free-floating entities in my life. They were somehow influencing my life, but I couldn't get a handle on just how. Then came the next layer.

Passion was peeled back to reveal that those things most important to me needed context in order to activate them in a way that would add real meaning to their expression. Without a story for my life, my passions were like having a really nice, new car with no place to go. I can only cruise around for so long before boredom sets in. I need some destinations - some errands to run, a friend who needs ride somewhere, someone to visit etc. Not many people are happy to be in a story where they are the main character who moves around aimlessly. We like having a plan, a goal, a mission, passion-driven purpose.

Context provided a way to layout my values inside a story that would excite me to make a commitment, That would help me get some clarity on my purpose, which would in turn allow me to focus on my plan and truly prepare for my future.

We shall see what happens before this layer is peeled back...