HR 3200 from a systems design perspective (Part II)

| September 8, 2009

Bending the curve indeed

In the first part of this three-part series, I briefly outlined the parallels between developing software and crafting legislation, while pointing out the great risks and issues in the latter. I also indicated what I felt were some of the general structural flaws  in HR 3200, the House bill on health care reform — not criticizing any actual proposals, but rather highlighting some of the design and implementation problems that make it hard to understand HR 3200 and even harder to predict its consequences.

Here in Part II, I’ll talk about some of the well-established maxims and heuristics of complex systems development, and how they apply to legislation in general and to HR 3200 in particular. (More after the jump.)

Gall

As far as I can tell, John Gall — in his out-of-print book Systemantics (1976)– was the first to observe in print that

A complex system that works is found to have invariably evolved from a simple system that worked. (p. 80, 1978 paperback edition).

Immediately after, he observes that:

A complex system designed from scratch never works and cannot be made to work. You have to start over,  beginning with a working simple system.

My co-blogger (over at ASIP) Bruce Henderson puts this another way:

Start out stupid, and work up from there.

There is large room for differing arguments here as to just where HR 3200 fits in, for several reasons.

First, HR 3200 isn’t “designed from scratch.” As noted in Part I, many sections of HR 3200 are modifying various existing laws and regulations, such as the Internal Revenue Code, the Public Health Service Act, Employee Retirement Income Security Act, the Social Security Act, and the United States Code.

However, leveraging upon and modifying several existing systems is not the same as building a “simple system that works” and evolving it into a complex system that works. I can create a large, complex piece of software that calls upon and even modifies existing systems and libraries — but that doesn’t necessarily mean I’m evolving something from a “small, simple system that works”. This is especially true when I’m pulling together from several disjoint or unrelated systems (such as those listed above).

Second, legislation is more robust than software, for exactly the differences outlined in part I, namely that legislation is executed by people rather than machines and operating systems. If I create an ill-formed piece of software, there’s a good chance it won’t even compile (or interpret); if it does, then it may run into linking or integration errors; and if it gets past those, it may crash, lock up, or behave bizarrely upon execution.

If, however, I create an ill-formed piece of legislation, it can be (and often is!) be put into practice, with various human either officially or unofficially working around the defects to make it “work”. Of course, that ‘deployment’ of the legislation may end up drifting or even veering sharply from the stated or actual intent of the legislation. (In a way, this is reminiscent of the early PL/1 compilers that would, upon encountering a syntax error, make a best guess as to what you might have meant to write and compile that instead.)

Courts can shift this ‘deployment’ in both directions. They may “find” meaning or functionality in the law never contemplated or even explicitly disavowed by those who crafted and voted for the legislation, or they may prohibit some portion of explicit functionality due to conflicts with the Constitution, prior judicial rulings, or simply their own judgment.  As noted in Part I, judges don’t always agree with one another, either, so whether a given piece of legislation (or a subportion thereof) is upheld, modified, or rejected entirely depends upon which courts or individual judges end up reviewing it.

Third, there are serious and compelling arguments as to how well the current government health care programs (such as Medicare and the VA hospital system) work, not to mention the government systems modified and relied upon by HR 3200 (such as the IRS and Social Security). While you may argue with Gall’s maxims above, I know of no serious systems designer who will state that it is possible to build a large, complex system that works from complex systems that work poorly, if at all. The quality of your original and leveraged systems provides an upper bound on the quality of your final system. To believe otherwise is to succumb to wishful thinking.

Maier and Rechtin

In The Art of Systems Architecting by Mark W. Maier and Eberhardt Rechtin (2002), the authors take a cross-discipline approach to systems architecting, including talking specifically about social systems in Chapter 5. The following passage from that chapter is of particular relevance to the overall purpose of HR 3200 (all emphasis in the original):

The first insight, which might be called the four whos, asks four questions that need to be answered as a self-consistent set if the system is to succeed economically; namely, who benefits? who pays? who provides? and, as appropriate, who loses?

The political arguments raging over HR 3200 are exactly over those four questions. In fact, Maier and Rechtin themselves foresaw those arguments, since they go on to use health care as an example:

Example: serious debates over the nature of their public health services are underway in many countries, triggered in large part by the technological advances of the last few decades. These advances have made it possible for humanity to live longer and in better health, but the investments in those gains are considerable. The answer to the four whos are at the crux of the debate. Who benefits — everyone equally at all levels of health? Who pays — regardless of personal health or based on need and ability to pay? Who provides — and determines cost to the user? Who loses — anyone out of work or above some risk level, and who determines who loses?

The problem with HR 3200 and with the arguments put forth to date on its behalf is that they have not systematically and credibly addressed those four questions. In fact, those arguing in support of HR 3200 and health care reform in general have often given contradictory answers to those four questions, undermining their own credibility, given ammo to their opposition, and (justifiably) undermining public support for HR 3200.

Along those lines, the authors also note that in architecting social systems, you face not just the constraints of normal system design — risk, performance, schedule, and cost — but two more: perception vs. facts. They go on to say:

Social systems have generated a painful design heuristic: it’s not the facts, it’s the perception that counts. Some real-world examples: . . .

  • One of the reasons that health insurance is so expensive is that health care is perceived by employees as nearly “free” because almost all its costs are paid for either by the the employee’s company or the government. The facts are that the costs are either passed on to the consumer, subtracted from wages and salary, taken as a business deduction against taxes, or all of the above. There is no free lunch.

Again, with great relevance to the current debate over HR 3200 and the whole approach of the House over health care reform, the authors state:

Like it or not, the architect must understand that perceptions can be just as real as facts, just as important in defining the system architecture, and just as critical in determining success. As one heuristic states: the phrase, ‘I hate it’, is direction. There have even been times when, in retrospect, perceptions were “truer” than facts which changed with observer, circumstance, technology, and better direction. . . . In the end, it is a matter of achieving a balance of perceived values. The architect’s task is to search out that area of common agreement that can result in a desirable, feasible system.

Maier and Rechtin end Chapter 5 with some heuristics they consider specific to social systems. Several are those already cited above, but here are a few additional ones (my comments are in brackets):

Success is the eye of the beholder [i.e., the US public] (not the architect [i.e., Congress]).

Don’t assume that the original statement of the problem [e.g., “45 million uninsured”] is necessarily the best, or even the right one. (Most customers would agree.)

In social systems, how you do something may be more important than what you do. (A sometimes bitter lesson for technologists [and Congress] to learn.)

It’s easier to change the technical elements of a social system than the human ones (enough said).

Maier and Rechtin have an entire appendix at the end of the book on heuristics for system-level architecting. Most of these are intended for software and hardware architecting; however, several have bearing for HR 3200 and the general effort for health care reform.

Plan to throw one away; you will anyway.

This comes from Fred Brooks’ classic work, The Mythical Man-Month, and appears to be highly relevant to what’s going on right now in Congress, where both conservative Democrats and Republicans are suggesting that the best approach right now would be to start over again.

In architecting a new [software] program all the serious mistakes are made in the first day.

As someone who has been dealing since 1995 with failed or troubled IT projects, I find that this is the maxim I keep coming back to. I think that the Obama Administration and the Democratic leadership in Congress badly miscalculated public support for rushing sweeping (and unexamined) health care reform into law given the profound economic problems facing the country (not to mention the massive Federal deficits).

Given a successful organization or system with valid criteria for success, there are some things it cannot do — or at least not do well. Don’t force it!

As noted in Part I, HR 3200 is “kitchen sink” legislation, trying to accomplish a variety of changes that are not necessarily related or dependent. I suspect that Obama and Congress would have been far more successful with a series of small, focused bills that had clear goals and clear limits. The problem with HR 3200 is that by trying to cover so much ground, it merely increases the overall size of the opposition — people with objections to a specific portion of HR 3200 find themselves uniting (directly or indirectly) with those objecting to other portions of HR 3200. By recasting HR 3200 into smaller, well-defined chunks, the opposition to any given chunk becomes smaller as well, increasing that bill’s chances of passage.

Group elements that are strongly related to each other, separate elements that are unrelated.

The shorthard version of this in software design is “high cohesion within a module, loose coupling between modules”. This is another argument for breaking up health care reform into smaller, well-defined and clearly-focused chunks.

If you don’t understand the existing system, you can’t be sure you’re re-architecting a better one.

And, I might add, if you don’t understand the proposed system, you can’t be sure it’s a better one. It is unclear that most of the members of Congress who are pushing HR 3200 understand either the current US health care system or HR 3200 itself (and all its implications).

I could include many more maxims here, but you are better off getting Maier and Rechtin’s book and reading it for yourself.

Part III will suggest a different approach to health care legislation using good practices from systems development and software engineering.

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Category: 2010 Election, Congress, Healthcare Reform, Information Technology, Main, Obama Administration, US Politics

About the Author ()

Webster is Principal and Founder at Bruce F. Webster & Associates, as well as an Adjunct Professor of Computer Science at Brigham Young University. He works with organizations to help them with troubled or failed information technology (IT) projects. He has also worked in several dozen legal cases as a consultant and as a testifying expert, both in the United States and Japan. He can be reached at bwebster@bfwa.com, or you can follow him on Twitter as @bfwebster.

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  1. HR 3200 from a systems design perspective (part I) | And Still I Persist | September 8, 2009
  1. xuinkrbin. says:

    Where’s part 3?