Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes and writes from Fort Hall, Idaho. Comment at www.marktrahant.com

If the United States government were a corporation, then the health insurance reform debate would have completely moved into its implementation phase. Essentially, the management and the board would have figured out the course of action, and then figured a way to execute that plan.

If that sounds easy, it’s not.

In the corporate world there’s a lot of thought given about how to take an idea and then make it so. Everett Rogers and his 1962 classic book, The Diffusion of Innovations, shows how “innovation is communicated through certain channels over time among members of a social system.” When you have a good idea (or a bad one) the execution runs up against deeply ingrained obstacles. So really smart people spend a lot of time on the implementation of ideas.

In my newspaper career I worked at large newspapers and small ones. In small ones we could execute lots of approaches, even trying ideas that flopped badly. (The great thing about a small newspaper is if an idea doesn’t work, try, try again.) But at large newspapers, well, change of any kind was difficult, slow and you had to sell the idea over and over.

Rogers demonstrated this problem in graphic form. He divided people in an organization into five groups: Innovators, early adopters, early majority, late majority and laggards.

So you convince innovators and early adopters until you build enough of a success story in order to convince the next group. Of course, some people will never be convinced and that has to be a part of the planning, too.

I’d like to think the Medicare and Medicaid debate followed the Rogers’ curve. On July 30, 1965, when the act was signed into law there was much opposition, a majority of Republicans in the Senate and just under half of the Republicans in the House voted “no.” There was no consensus – indeed the bill was as labeled (as Obama’s is now) as “brazen socialism.”

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Tags: buffalo post, Everett Rogers, Harvard University, Health Affairs, Health care reform, Mark Trahant, Medicaid, Medicare, Native American news, President Barack Obama, The Diffusion of Innovations, Theda Skocpol