What Health Market Innovation Could Learn from George Costanza
Do the Opposite
“It became very clear to me, sitting out there today, that every decision I’ve ever made, in my entire life, has been wrong,” the neurotic George Costanza tells Jerry in The Opposite (Season 5, Episode 22 of Seinfeld). “Every instinct I have, in every aspect of life, be it something to wear, something to eat — it’s all been wrong.”
The Opposite came right in the middle of the show's run and, maybe more than any other episode, it contains all the elements that have Seinfeld consistently at the top of TV Guide and Rolling Stone as the greatest sitcom of all time. Seinfeld revolutionized storytelling with its "show about nothing" premise, self-referential humor, originality and lasting cultural phrases ("yada yada," "no soup for you"). It won 10 Emmys out of 68 nominations during its original run from 1989 to 1998, and
The Opposite is a George episode, and George Costanza was always the greatest of Seinfeld's characters because he embodies the show’s core themes — neurosis, self-sabotage, pettiness, and social absurdity — more intensely and hilariously than anyone else. In The Opposite, George is even more down on himself than usual. At the diner, he asks Jerry and Elaine, "It's not working. Why did it turn out this way for me?" He speaks about the promise he once had, but now he knows his life is wrong and everything is the opposite of what he wants.
“If every instinct you have is wrong,” Jerry reasons, “then the opposite would have to be right.” So George decides to change course. Instead of his usual tuna on toast, he orders chicken salad on rye and immediately lands a date as a result. When interviewing with the New York Yankees, instead of praising George Steinbrenner’s management, he launches into a critique and gets his dream job.
Stephen Marche writing for Esquire in his piece, The First Seinfeld Episode You Should Re-Watch on Hulu:
"The Opposite" also demonstrates perfectly the technique of three interlocking plots that became Seinfeld's trademark. The two other plots are not as interesting as George's, granted, but they fit together so well. We see Elaine fall apart after she becomes addicted to Jujyfruits—"You know what's happened? I've become George," she moans at the end—because she insists on eating them instead of helping her boyfriend and her boss. Jerry discovers that whenever anything bad happens to him, something good happens right away after. He always comes out even. This discovery leads him to an entirely new level of total non-concern for the lives of others.
The cleverness of the structure is wonderful:
Not only are the plots intertwined, they seem to cause each other, even though there's no rational way they could. But the three plots are related in terms of the character traits they reveal as well: Each strand shows how awful the characters are. Jerry is elevated to an almost mystical level of social indifference. Elaine cares more about candy than other people. And George can only be a halfway-decent person if he stops being himself as completely as possible.
It would be wonderful to see health economists, market makers and big policy deciders and influencers the world over, but especially in the United States, willing to try a new course when the one they’ve pursued for decades has failed so spectacularly for so long. Instead, they are doubling down on their mistakes.
After a nine-month investigation into direct-to-consumer telehealth platforms launched by Eli Lilly (LillyDirect) and Pfizer (PfizerForAll), a group of senators last week released a report summing up the findings of an investigation, with the title “Big Pharma’s New Sales Scheme: Expanding Patient Access or a Virtual Pill Mill?”
The lawmakers — Democratic senators. Dick Durbin of Illinois, Peter Welch of Vermont and Elizabeth Warren of Massachusetts and Independent Senator Bernie Sanders of Vermont — wanted to uncover whether these platforms “steer patients toward particular medications and [create] the potential for inappropriate prescribing that can increase spending for federal health care programs.”
Warren, in an accompanying statement:
“Big Pharma continues to use shady tactics to squeeze patients and line its own pockets. While we’re working to lower costs for families, these giant companies seem to be propping up new telehealth platforms just to push their own drugs on patients who might not even need them. We need to hold Big Pharma accountable and stop this abuse of power.”
"Healthcare" Has Lost The Plot
Innovation and the commercialization of ideas do not happen because you want them to: they happen along the way to solving bigger problems, and those problems are solved by co-ordinating markets (industries) into new, interlocking plots, a master narrative around which to reframe the arguments, reshape the assumptions and recast the way in which economic systems (“ecosystems”) are not only governed, but come into being (‘ecosystem genesis’).
Memo to Senators Durbin et. al., as well as public sector leaders and executive management teams everywhere “working to lower costs” of healthcare, or pass along the cost of doing business in healthcare to consumers (see Double-Digit Premium Hikes Next Year ), or, even more mind-numbingly, “fix” a system that is not fixable (check out the 168-page opus of happy-to-glad edits to prevent collapse of the NHS)::
“Cost” of healthcare is not The Problem for government dysfunctionality to nurture, the myth to pamper, the self-sabatoge to sustain for generations (see below). This plot line creates the context for what we have today: leaders fragmented conceptually and tinkering at the edges, betting too much on the allure of technical potential, confusing operations for strategy, and then riding the bouncing ball for as long as possible, hoping not to be the one on the bottom when the ball bounces.
The problem for The Government + The Market to solve collaboratively and creatively, as an interlocking plot in a new strategy story, is positioning ‘the production of affordable health’ as the basis for Big System Competition. This is a different agenda for big leadership and big market innovation, where American Capitalism is directed at sustaining, and growing, ‘market access’ to the middle class. To drive this radical change, we have to see The Problem through a particular lens: it means choosing directions (positioning objectives) for a strategy to achieve, with outcomes (not inputs) guiding the process to construct, and manage, better economic systems.
Few things are harder to change than the minds of experts who have staked their reputations on a particular theory. Even in the most objective fields, the physicist Max Planck observed, “a new scientific truth does not triumph by convincing its opponents and making them see the light but rather because its opponents eventually die and a new generation grows up that is familiar with it.”
“Profit” Isn’t a Dirty Word
Healthcare is also a hard knock world for the “profit” minded. It doesn’t help when “profit” is seen as a dirty word. But that doesn’t have to be the case.
“Big Pharma’s New Sales Scheme: Expanding Patient Access or a Virtual Pill Mill?” is born from the same confused haze that has been haunting the American Way of Healthcare for decades. People are worried and working on the wrong things. Diffusion matters more than invention (see The Innovation Fallacy in Healthcare).
The biggest gap, in healthcare especially, is not in generating scientific evidence to verify technical potential, and even producing a pitch deck to sell said technical potential. It’s developing, and then managing, the Big System Change necessary to ingest and integrate our ability to produce promising technologies, which in turn produces better economic progress for the most people.
As the hit man Anton Chigurh asks his next victim, Carson Wells, in Cormac McCarthy’s “No Country for Old Men,” “If the rule you followed brought you to this, of what use was the rule?”
It’s time to go full bore against the grain.
/ jgs
John G. Singer is executive director of Blue Spoon, the global leader in positioning strategy at a system level. Blue Spoon specializes in constructing new industry narratives.