Last week President Obama gave a speech on health care. One of my favorite things about watching speeches such as this is seeing who applauds and who stands at each pause in the speech. One particular line had an interesting response:

“I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch.”

Approximately half of the viewing body clapped.

Before I go any further, I should admit that I know little about health care reform, but my gut reaction to that statement was disappointment. Something that I think has been drilled into me through 3 years of classes with hypothetical projects in human factors is that many times the best way to “fix” a system is to throw out everything you think you know about the system as it currently exists and try to perceive the root problem with fresh eyes. My reaction had nothing to do with what I think is right for health care — it was just my initial response to the words as a general statement.

But the more I think about it, the more contrived a notion that seems. Is it ever really possible to start from scratch rather than simply redesigning what already exists? In the case of health care reform, there is an emphasis on short-term solutions, which clearly necessitates redesigning rather than starting fresh. But if someone proposed a health care reform plan for 100 years down the road, what would it look like?

A professor today brought up the Pony Express as an example of a system. Over 100 years later, today’s mail system doesn’t look that much different. It’s still people picking up the mail, carrying it a certain distance for a fee, and delivering it to another person. The basics of the system haven’t changed. Even the Google Wave team has pointed out that email has always mimicked snail mail, despite the capability for it to be so much more with today’s technology. Technologies grow in leaps and bounds but it seems that systems evolve slowly and  methodically.

There will always be a need to redesign things. There will always be a need for a Band-Aid solution, something to fix the flaws from a previous system. In an ideal world we want to be able to revolutionize the system, but that seems like a method that is rarely feasible in practice.