Sunday, July 15, 2012

Wicked Problems and Health Care

The Supreme Court has upheld the Affordable Care Act.  In what has been called an act of pragmatism over ideology, Chief Justice Roberts wrote the majority opinion that allows the Act to stand.

Beyond the ideological lines that have been drawn, the existence of this Act says something dramatic about American society, and how we govern.  The rhetoric of the past dozen years has made many of us believe that the political schisms are so wide that we cannot decide any issue, no matter how minute.

The most interesting analysis comes in an article by Atul Gawande in The New Yorker.  Dr. Gawande is a physician, and has written interesting books on the medical realm, and social order in general.  His observation harks back to a social study done some decades ago:

In 1973, two social scientists, Horst Rittel and Melvin Webber, defined a class of problems they called “wicked problems.” Wicked problems are messy, ill-defined, more complex than we fully grasp, and open to multiple interpretations based on one’s point of view. They are problems such as poverty, obesity, where to put a new highway—or how to make sure that people have adequate health care.

Gawande also describes the process that opponents go through to rationalize opposition to health care -- or any major social/political issue.  In many cases, opponents have a basis or foundation of belief that is understandable, and I can respect those who have core belief sets.  But our social systems change, whether economic, governmental, demographic.  We need to change with them.

Grandfather Clock

As I got off the bus on a recent morning, I looked at the clock tower on Albany City Hall.  The hands were missing from the clock face.

My first thoughts were of Captain Kangeroo.  I watched that show regularly as a child.  I vividly remember the eerie feeling I got whenever Grandfather Clock, a regular talking character, was missing from his place in the corner.  Captain would explain that he was 'out for repairs', but I felt an acute sense of loss, as if Grandfather had been abducted or disappeared.  What's wrong with him? We should all be worried, Captain! What does Mr. Moose or Bunny Rabbit think, how will they act without their friend?

The missing clock left a tall section of faded paint in the corner.  It  reminded me of death, as if a favorite dog was no longer wagging its way around the house.

So it felt strange when I saw the empty clock face on the City Hall tower.  The perfect brown circle only had a dot in the middle, an analog device missing one long arm and one short, no numbers around its borders to measure against.  A lost face, no longer marking our day.