If you want to know if a meal is a good one, one way to find out is to taste it. That will tell you if the food is edible or not, all right. The problem is, you might get sick from the test.

How about smelling the dish? That is what dogs do; no matter how hungry they are, they smell the food first before they eat it.

But smell can be manipulated.

I suggest to you that there is a better way to evaluate what is submitted to you for consumption: Watch how the meal was prepared.

Imagine watching someone cook a very complicated dish while totally ignoring the recipe. You do not have to be a chef to conclude that what s/he is cooking won’t necessarily be edible, and you might feel ill just smelling it.

I have watched how both Hillary Clinton and President Obama developed their health care plans. Neither one was “cooked” properly, and that is why both plans had and are having difficulty obtaining the necessary votes to be implemented. Even if President Obama’s plan passes in Congress, there is a danger that so many political compromises will have to be made in order to force it through that, although it was designed as a racing horse, it might end up a three-legged camel.

What went wrong?

Problems vs. pre-problems

Both President Obama and Hillary Clinton made the same mistake: They used problem-solving technology when, because we live in a democratic society, what they actually had was a pre-problem. (The following insight uses Adizes tools, and I’m afraid only those who have read my books or been through training will be able to fully understand it.)

Both assumed that since they had a plan they liked and believed was a good one, that it would be implemented.

Both approached the problem as if they had CAPI (coalesced authority, power, and influence), when they did not. What they needed to do was to get the CAPI group together; establish that there was, in fact, a problem; and then take ownership to design the solution.

Instead, both Obama, and Clinton before him, finalized a plan without consulting the people needed to accommodate that plan. They skipped a necessary step in decision-making: They went from illumination to finalization, and only then submitted their plan for accommodation.

At that point, when efforts were made to accommodate the plan by suggesting some compromises, those efforts were resented.

The missing step had come back to haunt them.

In plain English, they developed a plan and then tried selling it. A common mistake. That is how most people approach problems: They decide on a solution and then try to convince others that their solution is a good one.

What often happens, however, is that the “buyers” might have their own finalized solutions, too. What we have then is two trains on the same track but going in the opposite direction, pushing, huffing, and puffing … but hardly moving. Or perhaps a better metaphor is two male moose locking horns for the favors of the female (the electorate).

Both Clinton and President Obama solved the problem first and tried to get CAPI later. Shoot first, ask questions later …


President Obama consulted the American Medical Association, which represents no more than 17 percent of doctors. The independent doctors were not heard. In developing his plan he consulted the insurance companies, but not the Republican leadership who had the votes he needed.

Hillary did worse. She consulted no interested parties whatsoever. Her plan was developed in secrecy, by “consultants” and “experts” – first-class chefs who, in their infinite wisdom, decided what their patrons should eat and then tried to force-feed pork to vegetarians.

What they should have done is gotten the CAPI group to “cook” the solution together.

They did not do this. They saved the conflicts for the end rather than handling them in the beginning – another classic mistake that I frequently encounter in my consulting work.

Problems must be solved by, among others, those who are going to implement the solution; otherwise, we end up with what doctors call “non-compliance”: The medicine is good but the patient ain’t taking it.

Wrong ‘road map’

The plan’s development did not follow an effective road map of decision-making.

First of all, I believe even the diagnosis was incorrect, because public outrage about the health care crisis was not loud enough to create the CAPI necessary to solve the problem.

I suspect the task was not well defined, either – because who should have the right to be insured is still under debate. (Should illegal immigrants be included or not?)

But even had the diagnosis and the task definition been done properly, the design characteristics of a desirable solution were handled badly, if they were handled at all. Why? Because the CAPI group, even had it been assembled (which it was not), would not have been able to agree on the criteria of the desired solution until the diagnosis and the task were settled first.

Without agreement on the diagnosis and the task, there is no chance of being able to develop the criteria of a desired solution and then to support the solution.

We have compounded mistakes here. It is obvious that the decision road map was not followed, the dish was not prepared correctly, and those that needed to “eat it” were served frozen steaks with burned potatoes.

It’s true that sometimes people will eat anything, because being hungry is worse. But it did not have to be a badly prepared plan, did it?

As you can see, I am not debating the content of the plan. I refuse to taste the dish. I know how badly it was cooked.

I feel like a doctor with antibiotics in my medical bag, watching people die from a disease that is totally treatable with the medicine I have.

Very painful.

Dr. Ichak Kalderon Adizes