I've been somewhat amused over the last few days as Democrats try to squelch the mailing of a rather interesting chart purporting to diagram the Democrat health care plan. It was originally going to go out to only a bunch of folks in a few congressional districts, but thanks to the brouhaha and the internet reach of The Washington Post, it is now in the hands of several million and theoretically billion.
So here's the Democrat future state chart; click here for a larger version.
And to be fair, here's a chart New Republic came up with to diagram the current state mess; click here for a larger version.
And to be even more fair, there's really no chart to be found of a Republican plan, which is a problem in itself. But the specifics of each plan, and the issue of congressional franking privileges, is not really the point of this post. I know better. Although I will say that a key provision of the Democrat initiative that requires employers to offer a health care plan or else pony up a 2-8% of wages penalty will blow the budget. Most employers pay far more than 8% of wages, and would consider simply dumping their plans and the administration headaches, paying the "penalty," and perhaps giving their employees a raise to boot, thereby dumping the cost onto the unexpecting taxpayer. I guess in an obtuse way that achieves the "portability" objective.
Those of us that use value stream maps as a tool to support lean transformation realize that these are not really value stream maps, but more interrelationship diagrams. However value still flows… and perhaps more importantly gets throttled or even blocked… at each relationship interface. The network of committees and centers and offices is rather stupendous. All with differing objectives, accountability, philosophies, and concepts of "value."
Sort of reminds us of the traditional manufacturing business structure. An order would be received by a "Center for Order Entry" which would then contact the "Office of Planning" to get scheduling information, who would then route the order to the "Material Control Committee" who would contact the "Office of the Financial Controller" for permission to procure raw material… well, you get the picture. If the organization began to implement lean, one important first step would be to change to a value stream based organization to streamline accountability.
Take the damn order and make it… fast and without waste. Period. That's all the customer really wants to pay for. And as our fellow blogger Mark would push, there is tremendous waste… and opportunity… at each stage of health care delivery.
Somehow I remember the Founders wanted government to be for the people, and not sticking it to the people. If the people are the customer, how can value be more effectively delivered? Who are the value stream managers, and what should their organizations look like?