A Memorial Day Commentary .... Thanks, America's Veterans .... It's Not We the People Who are Ungrateful for the Service and Sacrifices of our Honored Veterans .... It's the Government System, Stupid! .... Our Government is Nuts .... Problems with the VA, ObamaCare and Elsewhere .... A Government Bureaucracy is a Government Bureaucracy .... Nothing Productive or Customer Centric About It

There has recently been a bill introduced in Congress which would allow the head of the VA to fire employees for gross incompetence. WOW!


For far too long now our government bureaucracy has ceded its responsibility to conduct operations efficiently, effectively and fairly. (And lest we think it's only a VA issue, we all also know that it's virtually impossible to fire a teacher or most other government employees for anything short of being convicted of a major crime. The public sector union officials are too often in charge and the politically connected inmates are all too often running the asylum. That's the plain truth.)


Yes, we can all sleep well at night knowing that our duly elected public servants and taxpayer representatives are being vigilant about spending taxpayer dollars carefully and responsibly and assuring that our government employees are conducting themselves and acting in the absolute  best interests of We the People. NOT! What a catastrophe!


But wait. There's even more. President Obama sternly says that eventually he may even try to hold someone accountable for the VA scandal, depending on an official government investigation and the resulting report's contents to be released at a later and unspecified date.


{NOTE: Here's what I believe based on several decades of work in the private sector trying to please both customers and shareholders while working closely with my fellow employees. My performance was undoubtedly aided over the years by knowing that I didn't have "tenure." I was an employee terminable at will, if you will. That simply means that my employment could have been ended at any time at either the will of my employer or myself, and for any reason. Over several decades that 'terminable at will' arrangement worked out well for both my employers and me, and I was undoubtedly a stronger performer for having been held "accountable" to get the job done. But that's enough about my past. Let's return to the issues du jour in the public sector in general and the VA in particular.}


The VA's overall performance record is shameful, the issues are very real, and the problems of accountability and customer care have existed for a long time. And the inability or unwillingness of government officials to hold other government employees  responsible and "accountable" for their derelict actions over the years has contributed greatly to the fiasco.


And with respect to the alleged shortage of funds, my bet is that there will never be enough money for government as it is to do the job properly for our veterans, productively and in a high quality and cost effective manner. That's simply not the way government bureaucracies function. They cost too much and do too little for the benefit of their purported customers. Thus, taxpayers pay and the customer suffers.

But before continuing, let's make one thing perfectly clear ---- It's not the people who work for government who are at fault; it's the bureaucratic and non-customer focused and unproductive system within which they work. It's the system, Stupid!


The Bureaucrat Sitting on Your Doctor's Shoulder is a sad but true tale of woe about government and its sorry ways. While the article tells a specific story about medical care, it also exemplifies the way the government bureaucracy works or, better said, doesn't work for the benefit of both the health care system's customers and principal payers, aka We the People:


"The bond of trust between patient and physician has always been the essential ingredient in medicine, assuring that the patient receives individual attention and the best possible medical care.


Yet often lost in the seemingly endless debate over the Affordable Care Act is how the health-care bureaucracy, with its rigid procedures and regulations, undermines trust and degrades care. In my pediatric ophthalmology practice, I have experienced firsthand how government limits a doctor's options and threatens the traditional doctor-patient bond.

I recently operated on a child with strabismus (crossed eyes). This child was covered by Medicaid. I was required to obtain surgical pre-authorization using a Current Procedural Terminology, or CPT,   Your Value Your Change Short position                        code for medical identification and billing purposes. The CPT code identified the particular procedure to be performed. Medicaid approved my surgical plan, and the surgery was scheduled.

During the surgery, I discovered the need to change my plan to accommodate findings resulting from a previous surgery by another physician. Armed with new information, I chose to operate on different muscles from the ones noted on the pre-approved plan. The revised surgery was successful, and the patient obtained straight eyes.

               

However, because I filed for payment using the different CPT code for the surgery I actually performed, Medicaid was not willing to adjust its protocol. The government denied all payment.

Ironically, the code-listed payment for the procedure I ultimately performed was an amount 40% less than the amount approved for the initially authorized surgery. For over a year, I challenged Medicaid about its decision to deny payment. I wrote numerous letters and spoke to many Medicaid employees explaining the predicament. Eventually I gave up fighting what had obviously become a losing battle.

Every surgeon must have the option to modify and change a surgical plan according to actual anatomical findings that only become apparent during surgery. For example, if a general surgeon operates on a patient with a suspected acute appendicitis and finds that the patient is actually suffering from an ovarian cyst, that doctor must be free to change the plan and do what is best for the patient. The physician should not be denied payment simply because of a rigid government requirement to follow only the pre-approved plan.

We all expect that doctors will do what is best for us according to their best judgment. This is part of the oath that doctors take when they graduate from medical school. When the government interferes with the doctor's right to select the treatment course and perform a necessary procedure, the integrity of the entire health-delivery system is compromised.

This same rigidity affects the dispensing of medications. I recently had to contend with a pharmacist's unwillingness to go against Medicaid rules and dispense a prescription for an eye drop medication for my patient, a teenager with glaucoma. This disease, involving high intraocular pressure, threatens sight if it is not controlled by medication.

My patient's glaucoma had been well controlled by a particular eye drop dispensed in a bottle available only in one size containing a dosage that would last for two months. Medicaid regulations only allowed the pharmacy to fill a prescription for a one-month supply. Medicaid did not want to approve my prescription.

The pharmacist asked me if I would change the prescription to order another Medicaid-approved medication that would satisfy the one-month-only supply policy. I refused because my patient's ocular pressure was well controlled by the particular medicine I had requested. Her vision was preserved because of that drug's effectiveness. Only after numerous contentious calls with the pharmacist and Medicaid was I able to obtain the prescription. Why should a physician have to struggle with the government for the most effective care for a patient?

Another example involved a life-threatening situation. I examined a 14-month-old child with the symptoms of Horner's Syndrome, a condition that can be caused by a neuroblastoma (a malignant tumor). I ordered a CT scan of the neck and chest, as these are the two most common sites where this tumor appears. Medicaid approved a CT scan of the chest only. I spent several hours on the telephone pressuring my state's Medicaid officials before I received permission to have both the chest and neck scanned. The scan of the chest was negative, but the scan of the neck revealed a malignant tumor. A pediatric surgeon removed the tumor and the child is doing well.

Had I accepted Medicaid's protocol and only obtained a scan of the chest, that child might not be alive today. Is that battle with government bureaucracy one that you are comfortable having your doctor fight when your child's life is at stake?

People of means, as well as those who need substantial financial assistance, must be able to trust their doctors. When government sets up rigid protocols that control the surgical procedures a doctor may perform, that limit the medicines approved for treatment, and that deny a critical diagnostic scan that may save a patient's life, the bond of trust is broken."

Summing Up


When I worked in the private sector, we used to joke that the reward for doing a good job that day was that we got to keep our job and come back and do it again the next day.


That kind of talk, serious or not, sure wouldn't fly in the public sector.


As a taxpayer and citizen, however, I like the customer centered and shareholder focused ways of the private sector much more than the sickness of the government knows best bureaucracies. Again, it's not the people but the system that matters. And government bureaucracies suck.


Productivity, cost control, customer focus and customer satisfaction reign supreme to the private sector. In fact, they're all absolutely essential ingredients if a company and its employees are to succeed and have high paying and fulfilling jobs over a lengthy period of time. The market works its magic and customers rule the roost.


In the public sector, however, that's not the way it works. Not at all. Again, it's the system.


And that, my friends, is why things like the VA scandal happen, why the educational system sucks, why ObamaCare won't work out well, why Doctors are upset, and why government is so needlessly wasteful and costly.

.......................................................................

And there's lots more to say, but you get the message. And here's another message.

Happy Memorial Day weekend to one and all, aka We the People. And a special and heartfelt thank you, America's Veterans, one and all, from a grateful fellow citizen for a job well done.

I only wish We the rest of the People and our elected officials and government employees had done our jobs and fulfilled our obligations to you half as well as you have performed your duties and fulfilled your obligations as Americans.

On this summer starting Memorial Day weekend, may God Bless America and may He especially bless America's Veterans!


That's my take.


Thanks. Bob.