Tom Brady and the “tuck rule.” “Nobody knew health care could be so complicated.” “The financial world has become way too complicated and very secretive.” What could Tom Brady, Donald Trump, and Michael Lewis possibly have in common? Complexity. Lewis has analyzed it; Trump has discovered it; Brady has benefited from it. And the USA is entangled in it.
The complex “tuck rule” has been banished from the NFL rulebook quite a few years ago. But who doesn’t remember how its application gave Tom Brady his first playoff win with the Patriots in January of 2002? In the healthcare field, battles rage as intensely as in Foxboro stadium’s frozen tundra, with a complexity that would challenge the brainiest of NFL coaches.
Amidst the war to “repeal and replace” Obamacare during the summer of 2017, who doesn’t remember President Trump’s famous admission – in a live meeting, not in a tweet – about complexities in health care? And when it comes to explaining complex processes, in business and sports alike, the best selling author Michael Lewis has no peer. Liar’s Poker; Moneyball; The Big Short; The Blind Side; Flash Boys, are all page-turners that analyze intricate actions involving athletes, their managers, as well as the world of modern finance at its most cut-throat level, in the trading pits and the darkness of hedge funds.
Lewis decomposes every play, every investment decision, so as to explain how astute individuals can see things as they really are before most people, translating their foresight into a decisive advantage, in baseball, football and trading.
I am no Brady, Lewis or Trump. In some way, I am a contrarian to our age of relentless focus. But I have been fortunate enough to enjoy a very diverse education and professional life. Childhood years bicycling through Copenhagen in Denmark; teenage years in Rio de Janeiro in Brazil, with lots of beach and soccer; first job exploring for oil & gas in Patagonia, the Amazonian jungle and the savannas of Venezuela; then a career as a management consultant advising powerful CEOs; followed by the challenges of entrepreneurship in healthcare IT.
My head filled with many apparently unconnected experiences, I started from an early age connecting dots and finding patterns, e.g. what do the prosperous Danes and the habitants of Rio’s “favelas” have in common? Many of these patterns just stayed in my head, for decades.
Until one day my children – all raised in the Bay Area – challenged me: “Papa, we are a bit tired of hearing about soccer. Why, you could not write about our own American sports if your life depended on it!” This took place during a relaxing skiing holiday, and I took the gauntlet: “OK, après-ski card and board games canceled: I will write instead.” Thus was born the sports chapter of this book. And then I got the bug.
Why not write about something less fun than sports, but also more meaningful to our economic lives? As it turned out, the company I helped start from a blank piece of paper in early 2004 focuses on the most arcane and obtuse processes in healthcare, those governing reimbursements by insurance companies to hospitals. Such is the complexity involved that this business can only exist in the U.S. – there is no need whatsoever for it in any other country. So I decided to write about health care, an easy call. It was fun too.
Getting out of the weeds of CPT codes in reimbursement to attempt to paint a broad picture of our health care system and the inherent costs caused by its complexity was a rewarding exercise. Researching the historical roots of our system, and compare them to those in other countries, allowed me to bring together many observations I had made to myself after doctors’ visits here and abroad.
Energy, Finance, Taxation, and Laws & Legislations seemed to me other areas where complexity and opacity collude to make our daily lives more difficult. Not everybody loses, though. While we struggle to manage our savings in between financial crises, financial engineers thrive amidst sophisticated instruments nobody understands except those who designed them.
All this complexity takes a toll: is there any wonder people are angry throughout the country when managing one’s personal health or finances has become both complicated and uncertain? Throughout history, voters have turned to demagogues where they experience feelings of economic stagnation and cultural inadequacy.
The brave new world of technology can bring us both salvation – clean tech; electric cars; instant communications everywhere – but also potential damnation, what not with artificial intelligence and robots that could take away millions of blue and white collar jobs alike? Are there solutions to help us find simplicity the other side of complexity?
Yes, provided we do not throw out the baby with the bath water. Or, as Einstein wrote, much more elegantly: “Everything must be made as simple as possible. But not simpler.” Offering my solutions in areas as diverse as social welfare; health care; energy & the environment; regulations; finance & taxation, modest contributions to our national debate, was very satisfying. Hopefully, my efforts in writing this book will encourage others to do so and put pen to paper to share their own suggestions.
“Untangling the USA…” Reviews
Tags: complexity, energy, Finance, healthcare, history, legislating, solutions, sports, taxation, technology
“The author has a special talent in being able to explain the negative impact of complexity on U.S. society in very simple terms.”
– Professor Finbarr Bradley, Michael Smurfit Graduate Business School, University College, Dublin, Ireland.
” ‘Untangling the USA’ is a lucid and original exposure of the costly, fractious and self-imposed paralysis affecting our nation. It is a must-read call to action for policymakers at all levels.”
– Brian Dickie, Former President of Booz, Allen & Hamilton Inc.
“A fascinating look at all aspects of our world, from sports to government regulation. Etienne Deffarges’ unique insight is that we started with simple and clear policies, which grew increasingly complex over time. Why this happened and what to do about it leads to a captivating examination of our society.”
– Jean Kovacs, Partner, Hillsven Capital; Former CEO and Founder, Qualix Group, and Comergent Technologies; Global Board, Harvard Business School Alumni.
“A thought-provoking read for anyone trying to find simple and effective solutions to a complex and often ineffective healthcare system. This system inhibits our ability to make sound and logical decisions to reduce costs, and improve quality and access to care.”
– Robert Stanek, Former President and CEO, Catholic Health East; Past Chairperson, Board of Directors, Catholic Health Association of the United States.