Imagine that the receding COVID-19 pandemic had happened ten years ago. What would we have done for work? Would we have simply masked up and soldiered on as folks did with the 1918 influenza pandemic and accepted the inevitable, staggering death toll? Would we have suspended all business for a few weeks or months and used even more generous government borrowing and spending to keep our heads above water?
Fortunately, most of us didn’t have to make those choices. (“Essential workers,” like folks working in shipping, grocery stores, health care, and other fields, did have to make those choices, and we should recognize and applaud their work and sacrifice). Most of us had access to computers and high-bandwidth internet connections that allowed us to transition our work or school to a virtual space. But that would not have been possible even ten years ago. At that point, neither the software nor the internet was ready. The development of widely available broadband and the subsequent development of Zoom, Microsoft Teams, WebEx, GoToMeeting, Google Teams, and a half-dozen other virtual meeting platforms is a good example of the “adjacent possible,” the most famous idea brought forth by the physician and theoretical biologist Stuart Kauffman.
In his book “At Home in the Universe,” Kauffmann described early earth as (I’m paraphrasing here) a “primordial stew.” Atoms and molecules collided with each other and transformed each other in infinite ways, eventually sticking together into a set of new molecules that self-organized and self-replicated in a process we now call “life.” In his typically mathematical way, he points out how close to “infinite” he means when he talks about those new molecules:
“Biological proteins use 20 kinds of amino acids — glycine, alanine, lysine, arginine, and so forth. A protein is a linear sequence of [amino acids]. Picture 20 colors of beads. A protein of 100 amino acids is like a string of 100 beads. The number of possible strings is just the number of types of beads, here 20, multiplied times itself 100 times. That’s 10¹²⁰, or a 1 with 120 zeroes after it. Even in these days of vast federal deficits, 10¹²⁰ is a really big number. The estimated number of hydrogen molecules in the entire universe is 10⁶⁰. So the number of possible proteins of length 100 is equal to the square of the number of hydrogen molecules in the universe [emphasis mine].”
The complexity of life on earth, which is so daunting at first glance, seems much more inevitable when the interaction between such a vast number of molecules is considered. Here, a “trial” is two molecules interacting with the potential to form a new, novel molecule:
“Assuming that a “trial” occurs in a volume of one cubic micron and takes one microsecond, Shapiro calculated that enough time has elapsed since the earth was born to carry out 10⁵¹ trials, or less. If a new protein were tried in each trial, then only 10⁵¹ possible proteins of length 100 can have been tried in the history of the earth. Thus only a tiny portion of the total diversity of such proteins has ever existed on the earth! Life has explored only an infinitesimal fraction of the possible proteins.”
In the multi-billion-year history of planet Earth, we’ve experienced a tiny, tiny fraction of the proteins that could exist! The potential for other combinations of amino acids in new proteins represents the adjacent possible. Science writer Steven Johnson takes a more poetic and less mathematical approach to the adjacent possible. He describes it as “a kind of shadow future, hovering on the edges of the present state of things, a map of all the ways in which the present can reinvent itself.”
I went into this week’s blog post with the plan to talk about how the history of health insurance intersects with American ideals, what with Independence Day coming. But I veered into this topic instead because it seems the most American of all. We experience the health care system as it exists. We assume that its current temperature is what it always has been and always will be, like fish who don’t realize the temperature of their water or even know that water exists. But suppose we step back and see the tiny innovations happening in health care and the little experiments that succeed and fail daily. We can imagine an adjacent possible where everyone’s lives are better.
When you examine your benefit design, I hope you can keep that in mind. Paraphrasing Bill Gates, we all tend to overestimate the change that will take place in the next year, but we underestimate the change that will take place in the next decade. Good administrators, like good politicians, make changes that are popular and make people’s lives better. Think of minor problems in your benefit design that you can try to fix now. Some will fail, some will succeed, but in ten years, the effort to change them could genuinely transform health care. Just as we’ve not yet experienced the vast majority of possible proteins in Earth’s history, I’m confident that since the founding of the first American health insurance plan in 1850, we have tried only a tiny fraction of potential combinations of innovations in health care delivery.
Happy Independence Day.
As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.