Corporate Politics, Bureaucracy and Obamacare

Posted by PITHOCRATES - September 5th, 2013

Politics 101

(Originally published April 4th, 2013)

You won’t find many Union Workers filling out TPS Reports

In the movie Office Space we see how frustrating it is to work in a big corporation.  The office politics.  The bureaucracy.  The policies and procedures.  The frustration of having to answer to 8 different bosses after making a mistake.   Bumping heads with management at all levels.  And the mind-numbing frustration of getting your paperwork right.

Anyone who has ever worked in an office no doubt had their own TPS report moments.  And dealt with their own Bill Lumbergh.  So we laugh at poor Peter.  For we’ve been there.  And know his frustration.  For there is nothing worse than trying to work through a company’s bureaucracy.  Or dealing with layers of management that often appeared to be working at cross purposes.  And suffering under bad bosses.

Which is the whole purpose of labor unions.  To protect their workers from a business’ management.  And bad bosses.  Because unions say if they don’t management will just abuse their workers.  So unions shield workers from these unfeeling and inefficient bureaucracies.  Who are always introducing new policies and procedures to improve business efficiencies.  Things like TPS reports.  Which unions say only makes things worse for the worker.  So you won’t find many union workers filling out TPS reports.  Just the non-union office workers.

Dealing with a Bureaucrat is like a Grizzled Sergeant with 20 Years Experience reporting to a Junior Officer

Junior officers get no respect.  Comedian George Carlin served in the Air Force.  And said a common joke was to say when someone broke wind, “Captain who?”  They get no respect because they are bureaucrats.  They come out of their officer training with only book-learning.  While enlisted people have been gaining experience and learning how to do things on the job.  Then these junior officers come in with their book-learning.  And start telling these enlisted people how to do their jobs.  Despite these junior officers having never done their jobs.  Or understanding how to do their jobs.  But they will tell these people how to do their jobs better.

This is less of a problem in combat.  As junior officers typically have a short lifespan in combat.  For all the book-learning cannot replace the experience gained in actual combat.  Which is why lieutenants may command units but it is the grizzled sergeants with the combat experience that lead men into battle.  And a smart junior officer will learn everything he can from his senior sergeants.

Small business owners feel the same way about government.  For a lot of small business owners often go into business after working for someone else.  They’re like those grizzled sergeants in the military.  They’ve learned and done pretty much everything in a business.  Then decided to quit and start their own business.  And one of the first things they have to deal with is the mind-numbing bureaucracy of government at all levels.  City, county, state and federal.  A bunch of bureaucrats who never ran a business.  Who have no experience in their field.  And here they are.  Telling them how to run their businesses.  Like a junior officer out of the academy trying to tell a grizzled sergeant with 20 years experience how to do his job.

Under Obamacare Professional Bureaucrats will tell our Doctors how to administer our Health Care

In these complicated times if there is one thing everyone can agree on it’s this.  Bad managers, bosses, and officers are insufferable.  No one likes putting together ‘TPS reports’.  Or being told by 8 different bosses that they did something wrong.  And they sure don’t like people who don’t understand the first thing about their job or business telling them how they should do their job or run their business.  They especially hate people that can cite rules and regulations by chapter and verse who mete out some penalty or fine because they can’t cite those same rules and regulations by chapter and verse.

This will be the world of Obamacare.  And as much as EVERYONE hates these things at their workplace there are some who still want these same clueless bureaucrats and politicians to take over health care.  As if somehow these people who don’t know the first thing about treating sick people can do a better job than the grizzled veterans working in the health care industry.  Who spend more and more time filling out paperwork these days than actually seeing patients.  And the last thing they want is an even more bureaucratic system where they will have to report to 8 different people and agencies to treat a patient.  Where bureaucrats at the Department of Health and Human Services as well as the IRS will have their own coversheets for their ‘TPS reports’.

In the movie The Usual Suspects the character played by Kevin Spacey said, “The greatest trick the devil ever pulled was convincing the world he didn’t exist.”  For if you don’t fear the devil you may live a life more in line with the devil’s wishes.  Making it easier for the devil to get your soul.  Government is a little like that.  For it has a horrible track record of doing anything right.  Even in the finest military in the world the bureaucrat side of the military pays $100 for a $15.00 toilet seat.  And yet the government has tricked so many people into believing they want more government in their lives.  Even though government is nothing but the managers and bosses people hate where they work.  Bureaucrats who tell others how they should do their job by citing rules and regulations by chapter and verse.  But who really don’t know what you do.  Or how you do it.  Now these professional bureaucrats will tell our doctors how to administer our health care.  And God help you if you get sick and put the wrong coversheet on your Obamacare health care services requisition form.  Or leave an important income tax field blank.

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Corporate Politics, Bureaucracy and Obamacare

Posted by PITHOCRATES - April 4th, 2013

Politics 101

You won’t find many Union Workers filling out TPS Reports

In the movie Office Space we see how frustrating it is to work in a big corporation.  The office politics.  The bureaucracy.  The policies and procedures.  The frustration of having to answer to 8 different bosses after making a mistake.   Bumping heads with management at all levels.  And the mind-numbing frustration of getting your paperwork right.

Anyone who has ever worked in an office no doubt had their own TPS report moments.  And dealt with their own Bill Lumbergh.  So we laugh at poor Peter.  For we’ve been there.  And know his frustration.  For there is nothing worse than trying to work through a company’s bureaucracy.  Or dealing with layers of management that often appeared to be working at cross purposes.  And suffering under bad bosses.

Which is the whole purpose of labor unions.  To protect their workers from a business’ management.  And bad bosses.  Because unions say if they don’t management will just abuse their workers.  So unions shield workers from these unfeeling and inefficient bureaucracies.  Who are always introducing new policies and procedures to improve business efficiencies.  Things like TPS reports.  Which unions say only makes things worse for the worker.  So you won’t find many union workers filling out TPS reports.  Just the non-union office workers.

Dealing with a Bureaucrat is like a Grizzled Sergeant with 20 Years Experience reporting to a Junior Officer

Junior officers get no respect.  Comedian George Carlin served in the Air Force.  And said a common joke was to say when someone broke wind, “Captain who?”  They get no respect because they are bureaucrats.  They come out of their officer training with only book-learning.  While enlisted people have been gaining experience and learning how to do things on the job.  Then these junior officers come in with their book-learning.  And start telling these enlisted people how to do their jobs.  Despite these junior officers having never done their jobs.  Or understanding how to do their jobs.  But they will tell these people how to do their jobs better.

This is less of a problem in combat.  As junior officers typically have a short lifespan in combat.  For all the book-learning cannot replace the experience gained in actual combat.  Which is why lieutenants may command units but it is the grizzled sergeants with the combat experience that lead men into battle.  And a smart junior officer will learn everything he can from his senior sergeants.

Small business owners feel the same way about government.  For a lot of small business owners often go into business after working for someone else.  They’re like those grizzled sergeants in the military.  They’ve learned and done pretty much everything in a business.  Then decided to quit and start their own business.  And one of the first things they have to deal with is the mind-numbing bureaucracy of government at all levels.  City, county, state and federal.  A bunch of bureaucrats who never ran a business.  Who have no experience in their field.  And here they are.  Telling them how to run their businesses.  Like a junior officer out of the academy trying to tell a grizzled sergeant with 20 years experience how to do his job.

Under Obamacare Professional Bureaucrats will tell our Doctors how to administer our Health Care

In these complicated times if there is one thing everyone can agree on it’s this.  Bad managers, bosses, and officers are insufferable.  No one likes putting together ‘TPS reports’.  Or being told by 8 different bosses that they did something wrong.  And they sure don’t like people who don’t understand the first thing about their job or business telling them how they should do their job or run their business.  They especially hate people that can cite rules and regulations by chapter and verse who mete out some penalty or fine because they can’t cite those same rules and regulations by chapter and verse.

This will be the world of Obamacare.  And as much as EVERYONE hates these things at their workplace there are some who still want these same clueless bureaucrats and politicians to take over health care.  As if somehow these people who don’t know the first thing about treating sick people can do a better job than the grizzled veterans working in the health care industry.  Who spend more and more time filling out paperwork these days than actually seeing patients.  And the last thing they want is an even more bureaucratic system where they will have to report to 8 different people and agencies to treat a patient.  Where bureaucrats at the Department of Health and Human Services as well as the IRS will have their own coversheets for their ‘TPS reports’.

In the movie The Usual Suspects the character played by Kevin Spacey said, “The greatest trick the devil ever pulled was convincing the world he didn’t exist.”  For if you don’t fear the devil you may live a life more in line with the devil’s wishes.  Making it easier for the devil to get your soul.  Government is a little like that.  For it has a horrible track record of doing anything right.  Even in the finest military in the world the bureaucrat side of the military pays $100 for a $15.00 toilet seat.  And yet the government has tricked so many people into believing they want more government in their lives.  Even though government is nothing but the managers and bosses people hate where they work.  Bureaucrats who tell others how they should do their job by citing rules and regulations by chapter and verse.  But who really don’t know what you do.  Or how you do it.  Now these professional bureaucrats will tell our doctors how to administer our health care.  And God help you if you get sick and put the wrong coversheet on your Obamacare health care services requisition form.  Or leave an important income tax field blank.

www.PITHOCRATES.com

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Poor Quality Standards uncovered in the NHS a Glimpse into Obamacare?

Posted by PITHOCRATES - April 1st, 2012

Week in Review

Do you want to know what Obamacare will be like when they fully implement it?  Yes?  Well, then, I give you the UK’s National Health Service (NHS).  Only it won’t be as good as the NHS.  For the United States has far more patients than the UK does.  But even with fewer patients than the US the NHS bureaucracy is still cold, detached and, at times, deadly (see Health regulator ‘gagged own staff against speaking of failures’ by Rebecca Smith posted 3/30/2012 on The Telegraph).

The Care Quality Commission has been criticised for failing to act on concerns of residents being abused by care home staff and reducing the number of inspections to focus on registering organisations instead, a report said.

One of the key ways that poor standards of care in residential homes and hospitals come to light is through staff blowing the whistle yet the CQC shut down a dedicated hotline, the Public Accounts Committee said.

At the same time the CQC gagged its own staff when they tried to raise concerns about the Commission’s work, it said.

One board member told MPs she had tired [sic]to speak publicly about her concerns over the way the CQC was run but had been “ostracised and vilified”.

The report did not name the board member but it is understood to be Kay Sheldon, a psychiatrist, who gave private evidence to the Mid-Staffordshire Inquiry, into dozens of deaths of patients amid appalling standards of care.

Whistleblower hotline?  Gag orders?  Ostracized?  Vilified?  Patient deaths?  Appalling standards?  These are not the things they led us to believe would happen under Obamacare.  But they have them in the NHS.  Which is full of excellent doctors, nurses and caregivers.  So we can expect them in Obamacare.  And far more of them.  Because Obamacare will have far more patients than the NHS.  And it’s not because ‘bad’ people are sneaking into a national health care system.  It’s just the nature of a great bureaucratic beast.  That must spread diminishing limited resources to an expanding and aging patient base.  That turns health care into a game of numbers.  Accounting entries.  Even in the area of quality control.

The CQC has been ‘struggling for some time’, the report said, and the Department of Health is ‘only now’ starting to take action…

The CQC was formed in 2009 under a Labour government led by Gordon Brown, taking over regulation of healthcare, social care and mental health services.

Reports from the Health Select Committee, the Department of Health and the National Audit Office have all been critical of the Commission.

The PAC report said it has been ‘poorly governed and led’ and ‘we have serious concerns about the leadership, governance and culture of the Commission’.

Cynthia Bower, chief executive of the Care Quality Commission, resigned last month from the £195,000 a year post as a review by the Department of Health found widespread failures including a lack of evidence it protected patients, it was too reactive and inspectors missed neglect of care home residents.

Lady Barbara Young who was chairman when the organisation was set up in 2009, left after the Basildon hospital scandal in which dozens of patients were thought to have died despite the hospital receiving a ‘good’ rating from the Commission.

Government does not make things better.  No matter how ‘smarter’ government bureaucrats are than everyone else.  For that’s the belief of politicians and government bureaucrats.  That the world would be a better place if these ‘smart’ people took control.  And that includes health care.  So they can give large salaries (based on the current exchange rate that £195,000 comes to $312,195 US) to their likeminded friends.  Who can put all of their enlightened ideas into practice.  And what happens after they start running things?  Continued patient neglect.  And more patient deaths.  Despite all of their good intentions.

Mrs Hodge said: “The CQC completed less than half its target number of inspections. That is a serious failure that lets down patients and users of care services who rely on the CQC to protect them from poor or unsafe care.”

The Commission now has to register all 10,000 GP practices in England by April next year and the process has been simplified to an online application form in which partners will declare if they meet 16 pre-set standards including cleanliness, medicines management, patient consent, complaints and record keeping.

In pilots a quarter of GPs said they did not meet all the standards.

The report said: “We are concerned, however, that the Commission will simply be a ‘postbox’ for self-certified applications and that the process will not be sufficiently robust to give the public meaningful assurance that registered GP practices are meeting the essential standards.”

Bureaucrats love paperwork.  The more the merrier.  Put it online and they’re in paperwork nirvana.  Because they never have to leave their offices.  They never have to work late.  They never have to travel to these disgusting health care facilities (where they neglect patients and cause many to die).   Out of sight out of mind.  Ergo their system works.  Thanks to the honor system.  And as long as bad care providers identify themselves to the regulators so the regulators can quickly and efficiently complete paperwork addressing the situation.  And then file it electronically.  Confidant that they did everything they could to increase the quality of patient care.  And then they go home.  Trusting that the other bureaucrats in the system will take the appropriate action.  Thus improving the quality of health care.  Efficiently.  And cost effectively.  Leaving more money available for those large salaries they so enjoy.

“But it is also important to keep this in perspective. The main responsibility for ensuring care standards are met lies with front line staff and hospital boards. We must be realistic about what the regulator can do – its role is to act as a backstop when they fail in this task.

“The Commission had a troubled beginning, exacerbated by a lack of clarity about its role and a failure to provide the resources needed for it to meet the enormous and complex task it was given. Politicians must bear some of the responsibility for this – it is no good preaching the virtues of light touch regulation, and then blaming the regulator for not taking a more interventionist approach when problems emerge.

But there is a problem relying on the frontline staff when they follow orders from on high.  Their health-care-providing hands are tied.  They can only do what some bureaucrat in a far distant office allows them to do.  They’re doing the best they can in a broken system.  But when care or treatment is denied based on cost accounting performed in some office that never sees a patient their patients will suffer neglect.  And some will die.  In part from the refusal to give them life-saving treatment.  And in part due to the apathy people will feel when the quality of their care doesn’t matter as much as their meeting cost-reduction targets.  When they see patients suffer and die because they can’t do anything for them.  Because their requested treatment was denied.  It’ll harden the best of people.  Making their patients just numbers.  And not people.

And this will be the world of Obamacare.  For the NHS is full of great people.  Yet even they can’t prevent the ill effects of a bad system.

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FUNDAMENTAL TRUTH #22: “The only problem with health care these days is that it’s approached from a cost basis more than a medical basis.” -Old Pithy

Posted by PITHOCRATES - July 13th, 2010

THE PROBLEM WITH cost cutters is their vision.  They see costs.  Not the big picture.  Rockefeller was a notorious cost cutter.  Even determined he could save money by using a few less welds on his oil barrels.  But he saw the big picture, too.  He grew sales.  Something that cost cutters have trouble doing.  He didn’t.  In fact, he was so good that it took the government to stop his sales growth.

Roger Smith was a numbers man.  He managed costs.  Starting in the accounting department of GM, he reorganized GM to make better sense.  On paper.  To make nice, neat, bookkeeping-like ordered sense.  Things tend to work better on paper, though, than in reality.  Suffice it to say that few laud Smith as the greatest CEO of GM.

Robert McNamara was also a numbers man.  And he ran the Vietnam War by the numbers.  He carefully determined what U.S. forces could NOT attack.  (Any place outside South Vietnam was basically a sanctuary for the enemy.)  And he introduced the body count.  There was no strategy to win.  Just a policy to verify you were killing more of theirs than they were killing of yours.  Wars of attrition, though, take years.  And lives.  On both sides.  Americans don’t like sitting back and waiting for enough of their sons to die to declare victory.  McNamara failed to see the big picture.  Strategy.  He just tried to make the combat efficient.  Which did little to inhibit the enemy from making war. 

Managing costs is important.  It can improve profits.  But it can’t grow sales.  And if you can grow sales, you’ll be able to pay your costs.  Even if they are high and inefficient.  Few companies fail because they have a cost problem.  They file because they have a revenue problem.  They lack sales.  Cost cutting cannot fix this problem.  It can temporarily help reduce operating losses.  But if you don’t increase sales, you’ll probably fail in the long run.

There are detail people.  And people with vision.  Rarely are people both.  Rockefeller was.  Smith and McNamara were detail men.  They could not see the forest for the trees.  And this is the problem in health care.  We’re not looking at the big picture of medical care.  We’re looking at the details of cost. 

YOU WOULD THINK that doctors would oppose the government taking over health care.  Because when governments do, they tend to put salary caps on doctors.  Kinda diminishes the return on all that costly medical training.  I talked to two recently who favor a national solution.  Why?  Because of costs.  They like Medicare.  Because it’s simple.  Most of their patients are seniors.  So the bulk of their billings are uniform.  Medicare reimbursements.  They like anything that simplifies their overhead costs.  Private insurance companies don’t do this.  They’re not all the same.  Different people to call.  Different procedures.  Different approved tests.  Different paperwork.  And more of it.  And a bigger staff to handle it.

Doctors hate paperwork.  No doctor ever went through medical school because they wanted to shuffle paper.  Or because they wanted to fend off malpractice lawsuits.  Doctors are under a bureaucratic assault.  They spend more time with paperwork than with patients.  And paperwork does have a cost.  As do frivolous lawsuits.  A government takeover would standardize the one.  And, hopefully, eliminate the other.

I understand these doctors’ concern.  But they can’t see the forest for the trees.  Government is not going to approach health care from a medical basis.  They’ll approach it from a cost basis.  They’ll use statistical analysis.  They will manage care to maximize cost efficiency.  They will approach health care like Smith did in GM and McNamara did in Vietnam.  They’ll crunch the numbers.  Then determine what health care is cost effective.

THEY PROBABLY NEED no introduction.  Most people are family with the British comedy troupe called Monty Python.  Funny, a bit naughty and rather bookish, they’ve appealed to the masses across generations.  They spent a lot of time researching before making some of their movies.  Reading books.  The realism it adds made some of the funniest scenes.  A Roman centurion gives a Jewish terrorist a Latin lesson at the point of a sword (Life of Brian).  Dennis the constitutional peasant arguing with King Arthur (Monty Python and the Holy Grail).  And this scene from The Meaning of Life during a live birth lampooning the British National Health Service:

Nurse:  The administrator’s here, doctor.

First Doctor:  Switch everything on!

[They scramble to do so.  Machines turn on with flashes and sounds.  The administrator enters.]

Administrator:  Morning, gentlemen.

First and Second Doctors:  Morning Mr. Pycroft.

Administrator:  Very impressive. Very impressive.  And what are you doing this morning?

First Doctor:  It’s a birth.

Administrator:  Ah, what sort of thing is that?

Second Doctor:  Well, that’s when we take a new baby out of a lady’s tummy.

Administrator:  Wonderful what we can do nowadays.  [A machine makes a ‘ping’ sound.]  Ah!  I see you have the machine that goes ‘ping’.  This is my favorite.  You see we leased this back from the company we sold it to.  That way it comes under the monthly current budget and not the capital account.  [They all applaud.]  Thank you, thank you.  We try to do our best.  Well, do carry on.

This is funny.  Because it’s true.  When we approach health care on a cost basis.  You must show you need and use every piece of expensive equipment you have so it stays in the budget.  And the administrators administrating health care don’t understand health care.  They understand and make their decisions based on numbers in columns.  And speaking of numbers in columns.

 ONE THING STANDS out more than everything else when looking at numbers in columns.  In one cost column in particular.  Of all the costs in columns, one dwarfs all others.  The costs in treating very sick and very old people.  You can cut and trim the budget everywhere else but you won’t make a dent in overall costs.  Unless you cut and trim this one column.  Manage these costs.  Do some statistical analysis on these costs.  For if you cut THESE costs, it will make a difference.  It could even stave off bankruptcy without having to further raise taxes.  Yes, we can make the system more financially sound if we just stop treating so many sick and old people.

But it’s a body count mentality.  You have to willingly accept a defined number of additional deaths.  The Soviets were willing to trade 10 lives for one against the Nazis.   A steep price to pay.  But it did wear the Nazis down and lead to victory.  There was a similar ratio in Vietnam with America on the better side of that ratio.  But it was still too high a price for Americans.  It goes against our nature to think in terms of ‘acceptable’ losses.

But there will have to be a line that health care will approach but does not cross.  Where there are ‘acceptable’ losses.  Statistical analysis will take into account probable remaining years of life in a potential patient.  If few, the system will assign an appropriate value of care to match the health care expenditure with the expected return on the medical treatment.  People with more probable years of life left will receive more health care treatment.  People with fewer years left will receive less.  We’ll help manage their pain until they no longer feel that pain.  For it would be inefficient to spend a lot of money on someone who is going to die ‘soon’.

Perhaps I can best summarize this in song.

When you were young and your heart was an open book
You used to say live and let live
(you know you did, you know you did you know you did)
But in this ever changing world in which we live in
Makes you give in and cry
Say live and let die
Live and let die
Live and let die
Live and let die

(Live and Let Die, Paul McCarthy)

And that’s what bureaucrats will use all that statistical analysis for.  To determine who to let die.  You can sugarcoat it anyway you’d like, but it comes down to this.  A bureaucrat, not a doctor, will have the power of life and death as they decide what health care is appropriate and prudent.  As it must be under a system where bureaucrats distribute limited resources on a cost basis.  They will have no choice but to deny care that is not in the budget.

ONE PUZZLING THING about health care is that it is perfectly acceptable to approach it from a cost basis but not on a revenue basis.  For it is immoral to profit on health care.  Pity, because introducing market forces is one sure way to bring down costs.  People are willing to pay for medical services.  They pay for abortions.  And abortion clinics are readily available.  The free market laws of supply and demand work for abortions.  And so they would for other outpatient medical services. 

Instead of running a battery of tests because an insurance company requires this incremental approach of the cheap stuff first, you could go to an MRI (or some other expensive procedure) clinic and pay out of pocket.  Because they do nothing but MRIs, they achieve economies of scale.  The clinic makes money by offering low cost, high quality MRI scans that result in a high sales volume.  You benefit because you miss less work.  The doctor benefits because he gets your MRI scan results without additional paperwork to process.  I’m sure a market is there just waiting for an entrepreneur to come along.  I mean, if you can make money by performing abortions, you should be able to make money with some non-invasive, high-tech machines.

HEALTH CARE SERVICES will not become more affordable and more readily available by cutting costs.  If the bean counters try, they’ll damage the quality of health care.  Because the bean counters rarely look at the big picture.  You need someone with vision.  Because no cost cutter ever saved a business.  Or made the world better.

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