Sunday, February 27, 2011

The Health Care Triangle

In engineering, there is a well-known concept called the Project Triangle.  In any engineering project, you can choose to optimize for quality ("good"), cost ("cheap"), or speed ("fast").  However, you can only choose two of these three goals:

1. If you want a high quality product on the cheap, the project is going to take a long time.
2. If you want a high quality product completed quickly, the project is going to cost a lot.
3. If you want a product completed quickly on the cheap, the project is going to be low quality.

It is physically impossible to build a project that is high quality, cheap, and completed fast.

This truth is often represented as a triangle, as seen in this picture:

Many PHB's forget that the Project Triangle is a law of nature.  They insist on asking for the impossible.  They ask for a project to get done better, faster, and cheaper all at the same time.  Usually when you ask for the impossible, you get what is known in the business as a CF.

Health care reform has its own version of the Project Triangle.  I like to call it the Health Care Triangle (original, I know!).  Good and Cheap are still at two of the corners; however, the third corner is Universal Coverage:

1. We can have cheap, high quality health care, but not everybody is going to be covered.
2. We can have cheap, universal health care, but it is not going to be high quality.
3. We can have high quality, universal health care, but it is not going to be cheap.

The health care debate should center on which two of the three elements of the Health Care Triangle we as a society want.  Do we want to give everybody high quality health care?  If so, we are going to pay more for it.  Do we want to limit the cost of health care but still cover everybody?  If so, we are going to receive lower quality care. 

Reasonable people certainly can have a difference of opinion about which of the three elements we want to sacrifice.  For some, cost containment should be the goal of health care reform.  For others, universal coverage for all is what health care regorm should strive for.  However, there are many politicians who think that we can have it all.  They think that they can deliver on the promise of cheap, high quality care for all.  Unfortunately, those politicians aren't completely at fault.  We the People share some of the blame.  Many politicians fear (and rightly so) that if they come clean and make health care reform about choosing something to give up that they will get voted out by an angry electorate.  Therefore, they distort the debate by insisting that we can have it all.

If we want real, sustainable health care reform (and goodness knows the system can't continue like it is) then we as a country need to grow up, grow a backbone, and "pick any two".  Otherwise, we are headed for a CF.

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