Jeremy Fish, M.D. and William Bergquist, Ph.D.

Everything is interwoven, and the web is holy; none of its parts are unconnected. They are composed harmoniously, and together they compose the world. One world, made up of all things. One divinity, present in them all.  Marcus Aurelius, Meditations

COVID-19 may be the single most impactful disruptive force in contemporary healthcare history—yet it does not disrupt alone. It is fully interwoven in a complex web of health care perspectives and practices–and is fully connected to the many other societal challenges facing us in the mid-21st Century.

As Marcus Aurelius noted many centuries ago, everything is interwoven and COVID provides some of the most vivid thread for the tapestry being woven in contemporary life. There is much we can learn from our COVID experiences that would benefit not only our understanding of 21st Century health care systems, but also more generally the nature and dynamics of all complex systems in which we live and work.

Preface: Enter COVID-19/What Do We Do?

A challenging situation is easily portrayed regarding COVID. It is surging through the American health care system – which is one of the largest, most complex human systems on earth. As a powerful force of nature, COVID is disrupting a long tradition of system inertia in the United States. It is still not clear who will win. The American health care system has successfully resisted most bold new initiatives and external pressure from outside agencies—triumphantly overcoming regulators coming from the halls of justice and power.

What other industry that consumes trillions of dollars primarily settles its court cases for decades without trials? What other industry piles on thousands of new regulations, yet seems to experience little visible change in overall operations? There are likely no other industries that create more waste than the budgets of most nations annually with little progress in reducing those wastes despite decades of effort. The closest human-built innovation to disrupt healthcare in the past twenty years was the 2010 Affordable Care Act—which continues to struggle to reach more universal coverage at more affordable prices. It struggles due to enormous political push-back and inertia–despite rising public support and enormous financial investments.