Why Start With The Perfect?

You’re third in line for takeoff, finally ready to depart La Guardia and get to your lunch meeting in Chicago. The pilot comes on the P.A. for a last-minute cheery message: “Thanks for your patience. We hope to make it up once we’re in the air and get you to O’Hare on time. Or at least someplace not too far from there. We’re thinking maybe Gary or Indianapolis. As the President says, we shouldn’t make the perfect the enemy of the essential. So wish us luck.”

What if that were acceptable? What if we never got where we were hoping to go, and it was okay?

What are the implications when President Obama tells us that part of his philosophy is, “We shouldn’t make the perfect the enemy of the essential?” Sounds reasonable, in a way. Don’t want to be a perfectionist about everything. Wouldn’t be realistic. Never get anything done. Got to compromise, make a deal. Make progress of some kind.

I’m not so sure about throwing the perfect overboard. I keep wondering how can we ever know what really is essential unless we first know what the perfect looks like? Sure, when you’re going 500 miles per hour in an aluminum can at 30,000 feet, essential is you land in one piece, somewhere. But when you’re on the ground planning a trip, maybe the perfect includes getting all the way to your destination.

You want to know why this country is so confused about how to move forward on healthcare? One reason is, no one has given us a vision of what the perfect looks like. Without the perfect, we’re not even heading to Chicago and putting up with the reality that we might land in Cleveland. Obama’s vision for healthcare still feels to lots of people as if we’re just lifting off with no clear vision of where we hope to land.

Would you really want your team to design anything without first making the effort to get a clear picture of what the perfect might be? If we don’t attempt to imagine what the perfect is, let ourselves dream and reach for the stars, then we are giving up our greatest gift as human beings before we even start. Without a destiny that we can see and dream about and hope for, what is to guide our efforts? The journey of progress will be vastly longer if we don’t know where we’re going.

What if Frank Gehrey had listened to that board member (whom I’m certain existed), the one who said, “Now, don’t go all crazy Frank,” and never asked himself what the Disney Concert Hall should be like if he could create exactly what we wanted? What would I like the outcome to be of my open heart surgery? What kind of achievements would you like to have in your life? Do you want to start by thinking about all the compromises you’re going to have to make, or do you want to imagine what you want to do, first?

Now that I’ve won you over (at least for a moment) to the notion that we should try to imagine what perfect would look like, let me invite you join me in imagining what would a perfect healthcare system be like? I, for one, would toss in the principles that everyone would have the healthcare they wanted and needed. People would be educated about healthy choices, and the obesity rates would decline. Money in the system would go to caregivers. Overhead would be kept at a minimum. Compensation for doctors would incentivized quality outcomes. We would shift from a sickness to a wellness system. That’s top of mind for me.

What about you? You can add your own thoughts, or turn this upside down. But whatever the discussion, we need to be able to hold up for ourselves a clear well defined picture of where we’d like to be someday. Many people feel the perfect is, “Single Payer.” But I think whether that’s it or not, we need to see how it would actually be in reality. Maybe we even to imagine what would happen if the healthcare insurance industry were downsized or shut down. I have no trouble seeing it, by the way. I just imagine decommissioning old coal-fired electricity generating plants. Same thing.

Whatever our vision of the perfect is we will be, finally, ready to design our compromises with “political reality” (which means working with those Stakeholders Who Are So Large That No One Can Say Their Name). And most important, look at those compromises and determine whether they allow us to remain aligned with our vision of the perfect, or if they take us farther off track.

Without that clear picture of where we want to go, we will never get closer to it. With that vision of the perfect, we’ll always know what’s left to be done. That’s what leaders are for, by the way. To inspire us with a vision of the ideal, and then make the incremental steps that move us comfortably yet inexorably, forward.