What Business Consulting Can Do for the Healthcare Marketplaceand Democracy Healthcare reform may have dominated our

new cycle for the past few months, but by now its old news. Weve come to know all too well what pundits and pedants from every corner of the political spectrum think about the Affordable Care Act. In a cynical mood, one might go so far as to say that healthcare reform has done a better job of making money for the media than of helping Americans save it. In the last couple of weeks especially, weve heard all about the shoddy government website: what problems its facing, whos responsible, and what, if anything, it reflects about our abilityObamas ability in particularto reform the messy complex system that is American healthcare. But just when most of us are starting to feel that everything that can be said about healthcare reform must have already been said, a surprising blog post over at NPR on Tuesday sounded a new note over the familiar din. The unlikely characters in this new story are McKinseythe well-regarded business consulting firmand something called agile software development. *** The NPR blogprovocatively titled This Slide Shows Why HealthCare.gov Wouldnt Work At Launch, offering up an irresistibly simple and tangible diagnosis to a large, unwieldy problemdescribes a presentation McKinsey consultants gave earlier this year as part of an outside progress report for the healthcare website. Its a rare day when long professional reports capture the imaginations of a wide popular audience. But the NPR post received more than 450 comments in the first two days it was up. So what was it that made this technical consulting presentation newsworthy, much less fascinating? Probably the vivid picture it paints of two alternative metaphors for software development: This is a story of contrast between two popular methods of software development. One is called waterfall, the other, agile. Waterfall development favors listing a huge set of requirements for a system up front, letting developers go away for months (if not longer) and expecting a huge software product in the end. The agile method does the opposite, favoring work done in phases, delivering minimum shippable parts of a software system in weekly or biweekly cycles. This allows for iterating or adjusting to hiccups discovered in the previous cycle, changing features or quashing bugs quickly and avoiding getting an end product that doesnt look a thing like what your users need. Like many government projects, HealthCare.gov was developed under the waterfall approach and to its near doom.

Whats surprising here is the way two relatively specialized, academic ideas have found their way into a public forum. Theorizing about waterfall and agile methodologies has been around for a whilesince at least the early nineties. And business consulting is a wellestablishednot to mention highly esteemed, elite, and well-paidindustry. Both are usually invisible to the public, beyond their range of interests. But the NPR blog shows us how behindthe-scenes ideaseven those of business theorists and consultantshave much wider ranging implications, and opens up the public to a dimension of analysis beyond what we get from mainstream media. Even more surprising, perhaps, is that it shows us that metaphors matter. The metaphors software developers use to conceptualize their work shapes the work they do and the products they create. The linearity of the waterfall model translates into a linearity of production, whereas the agility of the alternative model produces greater flexibility and responsiveness. Why should we be surprised to find this out? Only because its something that never makes the news. The NPR post shows, in other words, how its possible to talk about a political issue without pigeonholing the discussion into something we already know. *** If you look closely at what all the big-name commentators have said about the problems Obamacares faced, youll find a kind of analysis that insists on reading those problems as political allegories. When the website fails, its really only a sign that the Democrats, or Obama, or socialism has failed. The impulse isnt to look carefully at particular circumstances but to inductively generalize to large-scale paradigms and belief systems and issue summary judgments. Why? Perhaps out of a deep-seated need to assign blame. Blame is immensely satisfying because it brings resolution. It says who was right and who was wrong. It absolves us of not knowing what it all means and the hard work of confronting details and ambiguities in order to figure that out for ourselves. What gets lost in this eclipse of the particular is an appreciation for complexity. Today its never enough to tell in depth whats happening and why; both writers and readers on the whole are dissatisfied by stories that dont have morals. We dont want the news or analysis, in other words; we want parables. We want to know how the stories we read in the news cycle illuminate broader concerns. We wantlike the title of the NPR blog suggestsshort-andsimple definitive solutions to problems so large we each, individually, have very little sense of them. We want, in short, to impose neat order on the messy chaos of political and cultural life. That temptation may not be one any of us can resist, try as we might: it is probably in the very nature of analysis to contain something in the way of allegory, obscuring the messiness of the particular for the more satisfying simplicity of the general. But that doesnt mean the allegories we tell cant be more or less right. So I want to substitute for the popular ideological allegories of politics an allegory of my own: an allegory of agility. What agility can teach us is how to appreciate a new kind of political and cultural analysis. In place of the oversimplifying and over-demanding analysis were used toparallel to the orderly demands of the waterfall approachagile analysis can teach us how to be more flexible and adaptive. It can teach us how to appreciate small-scale effects rather than expect large-scale perfection, and how to engage in political discussion without demanding once-andfor-all answers. In doing so, this unlikely metaphor from a McKinsey presentation just might give us a better metaphor for democracy.