Coronavirus & Green Swans

As much as I want to focus on the art and science of health care over the next few years, the only question I’m being asked these days is how the pandemic will play out in the coming months.  I’ve been saying for several years that we should anticipate major surprises in the medical marketplace, but I certainly did not anticipate the nature or magnitude of the disaster that is occurring all around us right now.  The best insight from my crystal ball is that we should not believe anyone who claims to know exactly what will happen. 

Having taught epidemiology at two medical schools and authored textbooks on clinical research, I have a professional opinion about the coronavirus—namely, I do not know how the pandemic will affect us when all is said and done, nor does anyone else.  My educated guess is that it varies widely across the country at any given time and over time in any given location.  Hence, I agree with Trump’s assertion that one-size-fits-all solutions are inappropriate, but I am appalled by his arrogant contempt for data-driven, science-based policies that incorporate differences between and within geographic areas over time.  His hunches are downright scary to anyone who has studied epidemics.  If Trump’s world view is wrong, which I believe it is, what is shaping up to be a catastrophic year could become a cataclysmic decade.  My serious concerns about climate change’s threat to health care would be trivial in comparison.

On that grim note, let’s look at two quotes that reflect my perspective of economist and artist.  First, a German physicist, Max Planck, observed, “The things we look at change when we change the way we look at them.”  Second, an American astronaut, Frank Borman, blamed the Apollo fire on a “failure of imagination,” that is, cumulative oversimplifications leading to disaster.  Juxtaposing these ideas via Janusian Thinking shows how I plan to use this blog for exploring the future of health care.  Imagination is a common denominator between economics and art as I learned them.  Simply put, if we want a better future for American health, we need to look imaginatively at the entire realm of possibilities for addressing its problems.  No tradition should be sacred when we reinvent health care for the post-coronavirus future.  All scientifically defensible alternatives should be allowed to compete for the scarce resources that we can afford to dedicate to the health of Americans once today’s disaster plays itself out—likely to be less than what we have been spending.

Nicholas Taleb has been quoted a lot lately in comments that a viral pandemic was not foreseen because it exists but is very rare, like a black swan.  Good scientific analysis of low-likelihood epidemics was being conducted by government and academic experts, but Trump terminated it early in his administration.  The point relevant to this blog is that we need to go one step further, to look beyond rare events to things that have never previously occurred.  Hence, imagining green swans is a key to rethinking the future of health care.  A future with no changes in traditional organization, delivery, or reimbursement—that is, a future with nothing new—does not lead to any exciting possibilities.  On the other hand, reinventing the medical marketplace to get a new and better return to health spending through private sector innovations in local marketplaces is exciting to me.  I hope I can make it exciting to you.

We need to look at what we could do if we get creative, not at what will happen if we simply let trends define the future.  I’m inspired by the words of another famous physicist, Freeman Dyson (1923-2020):

“I don’t think of myself predicting things.  I’m expressing possibilities.  Things that could happen.  To a large extent, it’s a question of how badly people want them to happen.” 

Freeman Dyson

Please join me in the forthcoming discussion of specific ideas about using science and art to build a green swan health system once we get beyond Covid-19.