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Design For Corruption--Why US Healthcare is Failing

Posted by: Bruce Nussbaum on August 28, 2009

I’ve lived all over the world, in countries that Americans often call “corrupt.” Peace Corps in The Philippines, journalism in Thailand, Argentina, China. But these days, the US is at least as, if not, more corrupt than any other nation I have lived or worked in. Yes, most of this corruption is “legal.” It is easy to pass laws that make lobbying legal but what is happening in Washington today is exactly what happens in Manila, Jakarta, Shanghai or Bangkok—buying influence to control policy for the benefit of the few.

The US has designed a corrupt political culture that undermines our meritocracy and makes a joke of the “public good.” Health care is the most glaring example. Read this amazing Business Week cover story about United HealthCare’s influence in Washington. We have a Congress and Senate full of people covered by a great public health care plan refusing to share it with the rest of the population largely because of the lobbying efforts of health care insurers who don’t want a “public” option that would give them competition. The story shows in detail how corruption is shaping our national health care system.

Ditto for bank reform and Wall Street reform. Despite incredible irresponsibility that brought the US and the world to the brink of another Depression, the financial sectors have escape any serious re-regulation. Why? Lobbying.

The World Economic Forum is starting a forum for designing large-scale social organizations. It should be with a case study of the US.

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Reader Comments


August 29, 2009 05:31 AM

"...every design problem begins with an effort to achieve fitness between two entities: the form in question and its context."

The insurance industry has abstracted the reality from the healthcare context. We're individually absolved of responsibility to make sure that healthcare is efficient. Efficiencies are difficult where care is 'free' for the taking.

Efficiencies only occur where true costs are borne by the recipient. Even Christopher Alexander recognized the significance of the forces of "economy" in design.


August 29, 2009 08:37 AM

At some point when living and traveling throughout the world you realize how unexceptional America has become (or always was?) in it's reliance on very traditional "old world" rule through insider power, privilege and connections. On a dollar value basis, we must be the most corrupt nation in history, but it is really the globalized similarities of the crony capitalists, nationalist fanatics, and elite power brokers that is striking. An American can feel quite at home anywhere now.

Tom Gerber

August 29, 2009 02:44 PM

Don't neglect the corruption at the State and local levels. It is pervasive. Despite our proud boasts we are a society of liars and cheaters.


August 29, 2009 03:21 PM

I've lived all over the world and am very familiar with the public option or universal health care. Bottom is coverage of the lowest common denominator. Coverage for basic health screening, sore throats, etc., but no detailed coverage or expertise. Often I would go in for lab tests, but never find out what the result was. Doctors would not want to commit themselves to a diagnosis, or solution to my problem case. What does work well in public health is cost cutting on everything, drugs, care, followup, etc. And yes advisory review panels are very much the norm... to decide whether you will get more expensive tests and health care such as MRI's that we take for granted in the U.S.


August 29, 2009 05:11 PM

I agree with your assessment, and saw the change occur before my very eyes. I worked on a fairly important committee in the US House of Representatives just after Nixon's impeachment. To control corporate and other political corruption, Congress established the PAC system. Boy, did that ever create a problem--money you wouldn't believe. It also created another problem: gridlock. You see, there are always two sides, and they both contribute. What you had was something akin to a big isometric exercise: two big arms (fed by PACs) pushing against each other, getting stronger, with no movement. We are moving into the next stage: creating "astroturf" movements fed by PR firms who give out mistatemens to the uniformed. God save the country.

Bill Daul

August 30, 2009 12:49 AM

My Nussbaum,

YOU ARE SO(!) right on. The other problem is the country keeps us too busy, too confused about issues to really do anything. We elect people that corporate America funds to run...this includes Obama (unfortunately).

I wish I didn't have to think about the following...the America was founded on violence, we only understand violence, we only react to violence. When there are MILLION-people protests in D.C. the congress people look out the window and laugh, thinking...well we don't have to change ANYTHING YET...THE PEOPLE ARE NOT REACTING VIOLENTLY...yet.

Martin Luther King ended violently and we physically abused over his short time with us.

Kent State and the Vietnam War...

Again, thanks for your note...too bad so few of us will read it and even fewer do anything about it.


Charles Pinneo

August 30, 2009 01:57 PM

The problem is that the news media have not called it corruption. But it is corruption right in front of our eyes. And the Republicans are digging their own graves by supporting corruption.

James Mason

August 30, 2009 03:47 PM

A welcome acknowledgement of how corrupt the US political system really is. When Washington lectures the world about morality without fixing its own mess, it is just seen as sheer hypocrisy that has no tangible positive effect on anyone else.

Fred Fickling

August 31, 2009 02:30 AM

Indeed - I have heard it said that the US has the best government money can buy!

Sergei Dovgodko

August 31, 2009 05:50 AM

I am glad we are finally coming to realization that the US is not that different from other countries in terms corruption.

At the same time, it is true that the country is far more advanced in legalizing the kind of corruption that truly matters (not banal $100 bribe for a minor favor).

One type of such legalized corruption is political contributions by business interests. While corporations already have formidable capabilities of influencing elections and policy, it is possible that it will get even better for them.The Supreme Court, while arguing so-called Hillary Movie case, could rule in favor of removing the financial limits of corporate political contributions.

This kind of development can open new horizons of aligning public policy design to particular corporate/private interests. Now, a financially well-equipped private entity can be more transparent, direct, and assertive in setting government priorities.

It could be interesting to even further and ask, what could happen if business would vote in elections instead of (often uninformed) people? What's good for business should be good for the country. Besides, according to Business Week, only 7% of people are self-employed in the US. If corporations vote, they could represent 93% of the population, a considerable improvement over the current low turn-out rates. The needs of recounts are likely to be low.

Another benefit could be cost reduction of campaigning as businesses could use tried and true efficiency improvement methods. For example, presidential candidates would not need to raise half a bullion dollars, as in the last presidential election, to win. Besides, the cycle time of campaigning can be reduced from 2 years to much shorter period.

Finally, it could be possible to eliminate PACs as direct corporate vote becomes possible. Another boost to efficiency!

Ray of NC

August 31, 2009 03:56 PM

As I see it, America has lost it's focus on the middle class.
The problem begins with the elitist right mentality which thinks that they can own people with a lack of appreciation for those who may be economically disadvantaged.
It then becomes finalized with the thinking of the democratic left who insist on treating America as thought her people were equivalent to the poor of third world countries.
The truth be told - neither side is for the bulk of American people. However; they have succeeded fairly well in reducing the middle class so there are less of the ruling class.
Once America figures out that both sides are busy stealing for the middle - then and only then can we hope (unlikely) to correct any of this mess.

You commented on Health Care and Banking.

Both systems are and/or were manipulated to reduce the significance of middle class.
HEALTH CARE: If you have a preexisting condition - the only significant way to afford coverage is if you ride on an EMPLOYERS insurance coat tail.
BANKING: To keep poor people poor one must use their desperation to hold them down. The housing market is a PERFECT example. They allowed people who wanted more to get too much so they went under with a bankruptcy. Now they lost their home, lost their credit ratings, and are at the mercy of rental companies who will make it difficult to rent in safer neighborhoods and (credit check based) gated apartment communities.


Look at minimum wage - how many advocates of minimum wage ACTUALLY gained from it?

How many were people striving for a middle class who are now just closer to the bottom of the wage scale.
With a stroke of a pen the lower middle class wage became low class poverty wages.

Kasthuri N Ravilla

September 1, 2009 02:23 AM

The US is fully embroiled in a system of exploitation. You can not change a system, where fear rules. Greedy and irresponsible are creating a vortex, which slowly destroys this great nation. You have to see the doctored protests on the video screens of the idiot (owned) boxes. I have heard and seen self flagelattion in India; but a different kind of it is happening in America. Whether the voter is a liberal or conservative does not really matter. The system had already stamped it on the voters' forheads "I'm the great LOSER"

Ankush Joshi

September 1, 2009 10:05 AM

Dear Mr. Nussbaum

I am US Citizen, living in India for last 4 years. Today, your article confirmed what has been observed by my Parents during their trips.

Once they understood the concept PAC, concept of Lobby, the comments was, it is none different than in India, just Legalized.

US is losing the Edge, Hi-Tech experts like me are chosing to live in a country where you live freely, in a system that is YET not controled by elites. I agree that there is a form of direct corrption, Palm Grease/Oil in the wheel, weight on a file, whatever you call it, it is still "DeCentralized" "Unorganized", it at least makes things move faster, get things done smoother. Most of all, it is localized, driven by a Greedy individual, not systemic.

In USA - we have lost ourselves to well designed, refined system of corruption, it will take violent revolution to get it in control.


September 2, 2009 12:42 AM

You're right. That's why we need LESS government intervention and not MORE. The only entity that can make corruption legal is government. So let's get it out of our way!


September 18, 2009 06:24 PM

Awesome song about the corruption

Henry Pelifian

February 2, 2010 08:25 PM

It is seldom stated so well so succinctly. It is heartening to know others see through the smoky veil of incessant praise by American politicians to their fellow citizens in pandering for votes.

Henry Pelifian

February 2, 2010 08:26 PM

It is seldom stated so well so succinctly. It is heartening to know others see through the smoky veil of incessant praise by American politicians to their fellow citizens in pandering for votes.


February 3, 2010 02:43 PM

Mr Nussbaum,
you are exactly right. I too have lived in the banana republics of this world and I see that the US has become a banana republic. As a friend used to say, "IN Russia, they control their citizens by speech control. In America we control our citizens by the mortgage on their houses." Americans are brain washed, and easily distracted by the Dem-Repub dirt throwing, while the politicians and the priveleged drink deep of the gravy bowl. Nothing will change until some day the president dissolves congress and the senate and orders out the army into the streets. By then of course America will be a third-world country with many Americans forraging in the landfills for food.

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Want to stop talking about innovation and learn how to make it work for you? Bruce Nussbaum takes you deep into the latest thinking about innovation and design with daily scoops, provocative perspectives and case studies. Nussbaum is at the center of a global conversation on the growing discipline of innovation and the deepening field of design thinking. Read him to discover what social networking works—and what doesn’t. Discover where service innovation is going and how experience design is shaping up. Learn which schools are graduating the most creative talent and which consulting firms are the hottest. And get his take on what the smartest companies are doing in the U.S., Asia and Europe, far ahead of the pack.

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