Can lessons of Iron Dome development be applied to health care?

The remarkable and inspirational story of the development of Israel’s Iron Dome missile defense system is told on the front page of today’s Wall Street Journal (Israel’s Iron Dome Defense Battled to Get Off Ground). It made me wonder: is there anything from that story that we can apply to our big health care problems?

To summarize:

  • The threat of short-range missiles fired at Israel has been apparent for several years.
  • Though people have discussed solutions, it was assumed by lay people and experts that a solution was unlikely or impossible. Either it wouldn’t work technically, would be too expensive, or would take too long –or all of the above
  • A senior official –in this case a Brig. General in charge of R&D at the Ministry of Defense– decided to make it happen anyway, despite opposition from almost all quarters
  • An inexpensive, effective system was conceived, developed, deployed and utilized within just a few years
  • Established defense contractors were brought into the project
  • The system was integrated into the existing armed forces once completed

My favorite section of the story is where Gen. Gold describes his reaction to an audit that showed required approvals were  bypassed:

Gen. Gould said in an interview that the auditor’s report misrepresented some facts, declining to be more specfic. He disputes any allegation that he broke rules, saying he simply sidestepped red tape.

“I just canceled all the unnecessary bureaucracy,” Gen. Gold said. “I left only the most crucial bureaucracy needed for success.”

There are some similarities with health care. There is a clear cost, quality and patient experience problem in this country that poses an existential threat to our finances. That’s why many people have embraced the Triple Aim to address all three issues and why the Affordable Care Act sets up all sorts of mechanisms for experimentation. Yet it is a long, slow process and it’s unclear whether we are really making progress. A big bureaucracy and top-down rule-making provide protections and funding, but also tend to stifle innovations.

Maybe the US health care system is just too big and complex a problem even compared with the missile threat to Israel. But I hope the story of Iron Dome encourages our own Gen. Gold’s to come out of the woodwork and take action.

November 26, 2012

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