Politics, Popularity and Leadership

DON'T CONFUSE LEADERSHIP WITH POPULARITY .... POLITICS ISN'T ABOUT LEADERSHIP

People confuse politics, popularity and leadership. In my view, leadership and politics don't mix well. On the other hand, popularity and politics do mix well.

Leadership is about persuading others to follow the leader to a place different from the one currently occupied. Often leadership means getting people to go where they would prefer not to go. It invariably involves changing the status quo, and as we all know, people are resistant to change.

Thus, my take is simple. Politics is about getting elected and staying elected. Accordingly, popularity and politics mix well. Leadership involves change and frequently doing what's right instead of what's popular. Change and politics don't go together. Thus, politicians aren't leaders. If they were, they couldn't get elected.

Leadership is an action oriented undertaking involving change. Usually those advocating change aren't taking popular positions. Leading change only requires that the leader has the respect of those following him --- not the friendship of them.

POLITICS IS LARGELY ABOUT GETTING GOODIES FOR ONE'S SUPPORTERS AND CONSTITUENTS

Thus, getting elected and staying elected involves popularity and not rocking the boat, except for one very important thing. If politicians are able to deliver goodies to their constituents, they become more popular. So getting more for the constituents is among the highest priorities of politicians. That helps vote getting at reelection time.

POLITICS IS NOT ABOUT CONTROLLING SPENDING ... MEDICARE AND THE NURSING HOME EXAMPLE

So what does this have to do with nursing homes? Everything.

OPM spending is the government knows best way of delivering goodies to constituents. Not fiduciary behavior but spending, pure and simple. Hence controlling that spending is not a consideration. Neither is staying within the budgeted amount. The beneficiaries of government expenditures don't complain when more is spent on them, even when it's improper spending. The more the better, in other words. It's all "free" stuff from the government anyway, so why worry about what it costs, even if the provider bills for inappropriate work done?

In that regard, Nursing Homes Said to Overbill U.S. is an interesting read:

"Hundreds of nursing homes overcharge Medicare every year for so-called skilled services, adding $1.5 billion in annual costs to the program, according to a federal report to be released Tuesday.

 

Read the full report

• Inspector General's Report on Inappropriate Payments to Skilled Nursing Facilities

About one-fourth of Medicare bills from facilities examined in the report were incorrect. The majority of these claims involved so-called upcoding, where a nursing home or other provider inflates the cost of its bill to Medicare by claiming more intensive services were done than actually performed. In other cases, nursing homes provided treatments that were inappropriate.

Documents show that facilities billed for high-intensity work, such as speech therapy and occupational therapy, that went to patients who couldn't benefit from it. One patient under hospice care refused physical therapy but was given it anyway, and Medicare was billed, officials said.

The report by the staff of Daniel R. Levinson, inspector general of the Health and Human Services Department, is part of a years-long initiative by that office to rein in costs at the 15,000 nursing homes that provide skilled nursing, for which the government paid $32.2 billion in fiscal 2012.

Such facilities offer physical, occupational and speech therapy, as well as assistance with activities of daily living such as eating and bathing.

"They're billing for therapy they don't provide or which the patient doesn't need," said Jodi Nudelman, New York regional inspector general for evaluation and inspections, who oversaw the study. "What makes this report stand out is the sheer amount of dollars inappropriately spent."

The findings come as President Barack Obama and lawmakers grapple with how to slow the rising cost of entitlement programs—a likely sticking point in upcoming negotiations to reduce the deficit.

Medicare, which insures the elderly and disabled, accounted for 13.5% of federal spending last year, according to figures from the nonpartisan Congressional Budget Office. The program is on pace to make up a greater percentage of federal spending over the next decade.

The Obama administration says cutting fraud, waste and abuse in Medicare is a key part of reducing the program's spending. As of July, the administration had recovered $3.7 billion in fraudulently obtained health-care money over three years.

"Almost every estimate is that 30% of U.S. medical spending is unnecessary, including fraud," said Elliott S. Fisher, a Dartmouth medical professor and co-director of the Dartmouth Atlas on medical disparities. "There's a lot of savings to be had."

Brian T. Cook, a spokesman for Medicare, said the agency has changed its payments to nursing facilities to prevent such abuses. "This type of systematic overbilling at the expense of taxpayers is unacceptable," he said. . . .

Greg Crist, spokesman for the American Health Care Association, which represents the nursing-home industry, said the association is "going to reserve comment pending review of the document."

Depending on the mix of services given to a skilled-nursing patient, Medicare paid between $214 and $623 per patient per day in 2009, which was the year sampled by the auditors from the Office of Inspector General."

SUMMING UP 

If 30% of medical spending is unnecessary, and if Medicare accounts for 13.5% of federal spending, and if federal spending is ~$3.6 trillion, then it would appear that big opportunities for taxpayer cost savings await leadership. 

Considerably more than $100 billion annually, in fact. Why wait? Why not lead, government knows best gang? Afraid it would be unpopular to some people? To whom? And so what?

Cheating taxpayers by charging government more than appropriate for services rendered is the norm in American health care. 

We've had Medicare since 1965, but billing practices still aren't under control at the end of 2012. We should be ashamed of letting our politicians pander rather than lead. What happened to MOM thinking and acting in government? Won't anyone lead the charge against waste?

Apparently not --- at least not yet.

And in my view, that's attributable to two fundamental reasons.

(1) Those non-government providers doing the billing get all they can get from the government, aka their fellow taxpayers, and (2) taxpayers don't bother to hold government payers accountable for spending our money wisely and properly.

 It's a simple case of pervasive OPM thoughtlessness versus a missing MOM approach.

Simply stated, there's been no incentive for our elected officials to see to it that MOM is treated properly.

In sum, politics has long been all about popularity and not at all about real world servant leadership.

And that's also why our financial condition as a nation is in ruins.

We can clean it up rather quickly, but only if We the People have the will to lead the way. Our politicians sure don't.

Thanks. Bob.