Morality versus the marketplace

This post may be jumping the gun a little, because I haven’t finished The Innovator’s Prescription yet, but I found myself drawing some interesting contrasts already between Christensen’s work and T.R. Reid’s (see my review of The Healing of America for a fuller consideration of his ideas).

The most striking contrast to me so far has been the different grounds from which each writer believes health care reform will emerge.

For Reid, the root cause of our health care woes is the poor moral decision we’ve made as a society that health care is a privilege, not a right.

All the other developed countries on earth have made a different moral decision. All the other countries like us–that is, wealthy, technologically advanced, industrialized democracies–guarantee medical care to anyone who gets sick. Countries that are just as committed as we are to equal opportunity, individual liberty, and the free market have concluded that everybody has a right to health care–and they provide it. One result is that most rich countries have better national health statistics–longer life expectancy, lower infant mortality, better recovery rates from major diseases–than the United States does. Yet all the other rich countries spend far less on health care than [we do].

Reid, p. 3

Once these other countries decided to make access to some baseline of health care a right, they were able to do the hard work it took to design and implement their distinctive national health care systems. And so the solution for the U.S., in Reid’s judgement, is first to settle this moral issue.

Christensen approaches the problem from a very different angle: for him, the solution to our health care problems will come from disruptive innovation among health care providers.

The problems facing the health-care industry actually aren’t unique. The products and services offered in nearly every industry, at their outset, are so complicated and expensive that only people with a lot of money can afford them, and only people with a lot of expertise can provide or use them…It’s the same with health care…At some point, however, these industries were transformed, making their products and services so much more affordable and accessible that a much larger population of people could purchase them, and people with less training could competently provide them and use them.

Christensen, pp. xix – xx

If the developments of other industries and products are any indication, the cost savings provided by disruption should lower provider costs enough to make health care affordable and contribute substantially to optimizing the U.S. health-care system.

I’m not far enough along in The Innovator’s Prescription to offer my two cents on which of these approaches I think is correct, but I think it’s worth noting that Reid’s focus on the moral dimension does not exclude the forces of competition and innovation. He’s not a business expert like Christensen (nor is his book meant to be a marketplace or economic analysis per se) but he does spend  a good deal of time speaking to the competitive forces at work in other health-care systems.

And on the flip side, and as I think he would be the first to admit, there is a strong moral and ethical center at the core of all Christensen’s work, stemming in part from his commitment to Mormonism and the LDS Church (the Church of Jesus Christ of Latter-Day Saints).

The takeaway for me from all this, in terms of what I can learn about leadership, is that although we can analyze a given problem from many angles–e.g., moral/ethical, macroeconomic forces, competitive pressures, consumer dynamics, and so on–our solutions must consider all of them to be truly persuasive.

Reid’s work, as strongly as I feel the pull of his moral imperative in my gut, lacks the economic sophistication in my opinion to lead to any real solution, or even function as an effective call to action–it just leaves too many of the important issues out of the equation.

And although Christensen’s work (at least the first seventy pages or so that I’ve read) is very compelling in terms of its analysis of competition and disruptive innovation, I find myself wondering whether the kind of innovation health care requires will happen in the face of so much opposition and inertia without a higher, moral imperative to catalyze the marketplace. And given the fact that, unlike computers or telephones, our inefficient health-care system is on track to allow 22,000 preventable deaths in 2010, aren’t we missing something important if we ignore the moral dimension of the problem?

As always, would love to hear what folks think of all this, so don’t hesitate to get the conversation started…

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