I came across Jane Jacobs about the same time as the ACA was being implemented and the thousands of pages of regulation were being written (bulldozing what little free market there was left in the health insurance business. I also came across THE CLUETRAIN MANIFESTO and the concept of technology allowing consumers to flip the table on the consumer-to-vendor relation model: turn CRM into VRM.
10 years after, the most disappointing thing about the ACA is what it did to health records and any possibility of consumers managing their vendors rather than being captured. Who would have thought that throwing billions of tax payer $ at something would create perverse incentives and lead to the capture of consumer data?
Imagine if something like Microsoft Health vault had taken hold and innovators built easy-to-use tools to move data in and out of the vault. Consumers could connect to digital apps. Consumers could share portions of their health history with brick and mortar providers. Consumers could have aggregated their own data with other consumers and solicited bids to provide them with catastrophic coverage or micro-coverage.
Instead, we have siloed data which is owned by a few select EHR vendors to use as they see fit (like selling it back to the providers who captured it in the first place).
It’s more my opinion than any sort of objective observation, but it seems that attempts to manage human behavior, whether through incentives or laws, frequently end up making things worse for almost everyone involved. Lots of people have difficulty understanding the difference between “complicated” and “complex,” as well as a stubborn refusal to take into account human nature.
In defense of Mr. Moses, he seemed to be all about efficiency, which is fairly critical when you're dealing with unlimited demand but limited resources. There is of course an aesthetic price.
And did he really propose a freeway through Washington Square? I have a hard time seeing the use of it, without leveling most of lower Manhattan.
I confess to a nasty part of my personality that feels that Mr. Moses’ beautifications, like Alvin Bragg’s marginal propensity to prosecute, is what New Yorkers want and vote for and therefore deserve, taken as a whole.
That is not to deny that both leave happy victors and extremely put-upon victims, in Mr. Bragg’s case some of them murder victims. But who am I to deny New Yorkers their democracy?
The problem with Urban Planners is . . . well, they're "planners". They apparently truly believe that with "good enough" plans and "enough" power they can bend human nature AND Reality into their own desired ends. So their plans continually try to take more choices from individuals, either AS individuals or as groups composed of individuals.
Those I've known well enough tend to direct their own lives by quite a lot of planning, and the fact that the plans in both their personal lives and in their role in the community frequently turn out badly does nothing to dissuade them from proposing a new, better answer that includes more power and more planning.
When pressed they will complain that the reason their own lives don't go as planned is not tat the plans might be flawed, but that "forces outside their control" thwart them.
And the reasons their plans for the community turn out ill is that individual humans (not themselves, of course) are self-centered, greedy, stupid, and incapable of good planning.
Their answer in either case seems to be to get more power to force the dummies who mess up their plans to shut up and do what they're told.
I came across Jane Jacobs about the same time as the ACA was being implemented and the thousands of pages of regulation were being written (bulldozing what little free market there was left in the health insurance business. I also came across THE CLUETRAIN MANIFESTO and the concept of technology allowing consumers to flip the table on the consumer-to-vendor relation model: turn CRM into VRM.
10 years after, the most disappointing thing about the ACA is what it did to health records and any possibility of consumers managing their vendors rather than being captured. Who would have thought that throwing billions of tax payer $ at something would create perverse incentives and lead to the capture of consumer data?
Imagine if something like Microsoft Health vault had taken hold and innovators built easy-to-use tools to move data in and out of the vault. Consumers could connect to digital apps. Consumers could share portions of their health history with brick and mortar providers. Consumers could have aggregated their own data with other consumers and solicited bids to provide them with catastrophic coverage or micro-coverage.
Instead, we have siloed data which is owned by a few select EHR vendors to use as they see fit (like selling it back to the providers who captured it in the first place).
It’s more my opinion than any sort of objective observation, but it seems that attempts to manage human behavior, whether through incentives or laws, frequently end up making things worse for almost everyone involved. Lots of people have difficulty understanding the difference between “complicated” and “complex,” as well as a stubborn refusal to take into account human nature.
In defense of Mr. Moses, he seemed to be all about efficiency, which is fairly critical when you're dealing with unlimited demand but limited resources. There is of course an aesthetic price.
And did he really propose a freeway through Washington Square? I have a hard time seeing the use of it, without leveling most of lower Manhattan.
I confess to a nasty part of my personality that feels that Mr. Moses’ beautifications, like Alvin Bragg’s marginal propensity to prosecute, is what New Yorkers want and vote for and therefore deserve, taken as a whole.
That is not to deny that both leave happy victors and extremely put-upon victims, in Mr. Bragg’s case some of them murder victims. But who am I to deny New Yorkers their democracy?
The problem with Urban Planners is . . . well, they're "planners". They apparently truly believe that with "good enough" plans and "enough" power they can bend human nature AND Reality into their own desired ends. So their plans continually try to take more choices from individuals, either AS individuals or as groups composed of individuals.
Those I've known well enough tend to direct their own lives by quite a lot of planning, and the fact that the plans in both their personal lives and in their role in the community frequently turn out badly does nothing to dissuade them from proposing a new, better answer that includes more power and more planning.
When pressed they will complain that the reason their own lives don't go as planned is not tat the plans might be flawed, but that "forces outside their control" thwart them.
And the reasons their plans for the community turn out ill is that individual humans (not themselves, of course) are self-centered, greedy, stupid, and incapable of good planning.
Their answer in either case seems to be to get more power to force the dummies who mess up their plans to shut up and do what they're told.
In my opinion one of your best pieces, thank you!
Healthcare in the USA is fourth party payer. None of the decision makers pay the bills. That distorts everything.
Providers welcomed the advent of health plans. It made it easier to get paid. Collections were always a problem.
Improve healthcare finance and we might improve healthcare. Obamacare made innovation much more difficult.