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Over the course of this upcoming presidential election, and for reasons I’ll get to later, the stridency factor in the debate over health care reform is bound to go up a notch or two. The candidates are putting health care front and center as a major issue, some a bit more thoughtful than others. And I suspect that health care stylists everywhere will be provoked into imposing their views or our ear-space whether we choose to listen or not.

But for the moment, I don’t want to get into the specifics of contending views here, as much as I want to talk to how we go about our thinking in health care. One interesting way to see the current debate is through a notion now making the literary and intellectual rounds — the Black Swan. At the risk of being faddish, I think it’s worth exploring for a minute.

A Black Swan is a rare event we never see coming, has extreme impact, and after it occurs, we rationalize that it was ever so predictable. Nassim Nicholas Taleb, author of popular book in question, argues that history and societies do not proceed along some linear line, but “go from fracture to fracture, with a few vibrations in between.” It is the singular, the unseen, the accidental and the unpredicted — and our “chronic underestimation” of these possibilities — that account for the FUTURE straying from any course we initially envisioned.

“We overestimate what we know and underestimate uncertainty,” according to Taleb. We overvalue facts, entertain illusions of understanding, and suffer from “retrospective distortion” when considering the lessons of history. We compress our knowledge and understanding of the world through our propensity for stories, and constantly mistake the map of the world for the world itself. We pay scant attention to the “silent evidence” or “silent consequences” of what we propose, and we know what is wrong with a lot more confidence than we know what is right. And when the gap between what we know and what we think you know becomes “dangerously wide”, it is here where Black Swans are produced.

Health care, and especially the financing of health care, is a human endeavor that produces more negative Black Swans (they hit hard and hurt) than positive ones. Without the money in the right places at the right times, many bad things, both predictable and unpredictable, happen in health care as a result.

If we take Taleb seriously for the moment, one should expect a lot more humility in the talk we hear about how to change the health care system. But, being overwhelmed by the complexity and chaos of health care, and by the devastating consequences of what is wrong, we fall back on our need to simplify. In doing so, we underestimate the contribution that subtle changes make to the creation of major catastrophes.

Taleb’s answer to how to avoid being immobilized by a full appreciation of what he is saying, is to be an empirical skeptic and always keep an open mind. It is all we humans can do. It’s not easy, however.

Let’s take for example the upcoming release of Michael Moore‘s new movie on health care, SiCKO. This week the movie will debut at the Cannes Film Festival and be in theaters starting June 29th. The orchestrated buzz (subscription required) on the movie is building, and according to the producer, Harvey Weinstein, the new release will “ignite the country once and for all to deal with health care.”

I suspect the movie could do just that. It will not be humble. The movie could put all that is wrong in health care into a compelling narrative that may capture the national imagination. If it is like his other movies, it will take no prisoners. Names will be taken and there will be enemies identified. It will be a good story. People will find satisfaction in the “message”.Those who try to nickel and dime the movie with criticism of this or that point will probably be confronted with the mass certainty of the movie’s POV.

Yet, how all that certainty translates into what is right for the future of health care will remain to seen. For Taleb, that means going beyond the story, beyond the simplicity of the tabloid mentality, beyond the arrogance propping up what we do know, to a better appreciation of what we do not know. Let’s not let that gap between what we think we know, and what we actually do know get too wide. Otherwise, the surprises in store may be far from what we have been led to expect.