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Towers of innovation?

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Last October, Late Night TV show “Jimmy Kimmel Live” sent a reporter out to do“man on the street” interviews, asking whether passersby preferred the term “Obamacare” or “The Affordable Care Act.”

Most of the people interviewed offered perfectly logical (to them, at least) explanations of why they thought the Affordable Care Act was much better than Obamacare.

It was a funny bit, but in the end, the ignorance of a program as pervasive and societally changing as ACA was just… sad.

Yet who can blame these hapless interviewees? Neither name is an apt description of what the plan is today. As it has rolled out, huge chunks of it have been deferred, redefined and de facto rewritten by the White House and HHS. Perhaps a name change would help. All it would take is a pen and a phone. I have a modest suggestion for the new name. Let’s call it “Jenga Care.”

The government would have to purchase (or more likely, appropriate) the name from Parker Brothers, of course, but what could be more descriptive? If you have played the game you will recall that 54 wooden blocks are stacked in 18 levels to form a tower. Think of the blocks as the individual tenets of PPACA and the resulting tower as the entirety of the law.

Players can remove a block from any level except from below the incomplete top level. Each subsequent player gets a chance to coax out a block, trying not to topple the tower. The game ends when the tower falls. This seems to me to be a much better analogy for PPACA, not to mention a more powerful visual. Imagine how effective it would be if we had the Jenga tower equivalent of a National Debt Clock.

Every time the administration pulled out another block and delayed or discarded it, we could hold our collective breath and watch to see if the tower tumbled. If it didn’t we would breathe a collective sigh (some positive sighs and a whole bunch of negative sighs — at least according to the most recent polling). We would wait until the next block was inevitably removed, the tower becoming ever more precariously perched on an incomplete foundation.

This begs the real question, however. When the tower falls, what will happen to the health care system in America? For example, the blocks that have already been removed create a very dicey financial situation for insurance companies. Some of the more spirited and passionate comments to a previous column about risk adjustment mechanisms were clear in their opposition to “bailing out” insurance companies. Yet if the insurance companies cannot find a model in which doing business makes sense, do we move that much closer to a single payer system? Was that part of the grand design? Regardless, will new private sector models create purchasing and delivery paradigms we can’t imagine today?

In the January 2009 issue of Managed Care, Clayton Christensen, who coined the term “disruptive innovation,” posited that the real reason health care remained expensive and inaccessible is that it had not yet been disrupted. While that has certainly changed, the real question to be asked today should be more about the innovation than the disruption.

Whether it is the end of the network-model health plan that Christensen wrote about, or whether insurance companies as we know them are about to experience cataclysmic change remains to be seen. Responses to the “Doc Shock” consequence may be the canary in the consumer coal mine.

Informed and engaged consumers are the most disruptive force in any market. In the wake of Jenga Care, many individual consumers are shopping for health insurance for the first time; emerging from their employer-based cocoons for the first time since World War II.

If we are fortunate about how the blocks tumble, the real question is this: What changes will consumers demand of the market, and who will respond with innovative solutions?

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