New to the Book Club
Why do our institutions and systems, including healthcare, seem to be getting more complex and more costly but not better? This fascinating book argues that we have lost practical wisdom – the ability to balance the need for reasonable rules and standards with doing the right thing. The law of unintended consequences applied to systemic rule-making. The authors lay out dozens of examples of well-intentioned rules that backfire, creating worse problems than the original. My favorite example is “smart” incentives to stop doctors from doing too much (fee for service) that now reward them for doing too little (underservice). It takes practical wisdom to translate general goals into concrete action. The authors outline how we have eroded practical wisdom and how we can build it again.