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Can Government Run Systems Function Efficiently And Cost Effectively?

Stanley Feld M.D.,FACP,MACE

It has been proven over and over again that government does not run its systems efficiently and cost effectively.

Think of the post office, the railroad, the military services, the EPA and the IRS, to name a few. One could go on and on and come up with the same answer to the question. No.

The same holds true for government’s goal to control the healthcare system. It will not work. It has already proven to not be cost efficient or effective.

The Federal Government’s goal is to take over more and more systems operating in the life of the average American. The excuse is to help all Americans live a better life, to help the poor and under privileged. Instead it has kept the poor dependent on government, poor and under privileged.

“Each according to his abilities and each according to his needs” has not worked wherever it has been tried.

Government’s real goal is to have power over citizens. It is to make citizens dependent on the central government.

It is hard to find an example on the planet where this strategy has worked for the people it claims to help.

The results are also just the opposite of what the U.S. Constitution guarantees.

The evolution of the VA Hospital System is a stunning example of how government controlling a system does not work. No matter how much money the central government throws at the system it does not help. Noble goals always go astray. It is because the structure and the incentives in the system are wrong.

No one seems to focus on the main defects. The most important questions are:

Who is the main customer?

What motivates the main customer?

How do you devise a system that fashions incentives to motivate that customer to help make the system work?

It is not a larger bureaucratic structure with larger budgets. Larger bureaucracies move the system further away from the goals of the main customer.

It is not a series of regulations that impose punitive measures on providers and customers who are in the system.

It is not guarantees of tenure for managers of the system.

It is a guarantee to have managers of the bureaucracy listen and understand lower managers in the system who point out the deficiencies in a system.

The larger the bureaucracy the more difficult it is to personalize the system and have participants in the system help and help make the system work. Bureaucracies isolate themselves from the main customers in a system. It is the reason they do not work.

Large corporations in the private sector fail also. These corporations form large silo like divisions that construct systems that do not relate to the main customers or each other.

Large corporations sometimes understand the dynamic and try to reformat the corporation to service their customers. If they do not, their product fails

The people do not have the power to force the government to service them, the customers. Citizens can vote their representatives out of power. The government tries very hard to keep the main issues that disrupt systems out of public view.

There are many government agencies and systems that are failing. Our representatives never fix the systems. Our representatives do not listen to the people who are involved in the systems or who run the systems.

The VA hospital system has had problems since at least the end of WWII. It came to a head since the war in Iraq and Afghanistan.

Veterans Affairs Secretary Robert McDonald had been a successful CEO in the private sector. He made some significant changes in the operations of the VA at the onset of his tenure.

He also needed a $16 billion dollar infusion through the passage of the Veterans Access, Choice and Accountability Act to keep the VA Hospital System open after the scandals in VA care came to the publics awareness.

As government bureaucracies usually act, congress and the president ordered independent multi-consulting firms to audit the VA and tell government how to fix the VA Healthcare system.

Analysts from Mitre Corp., Rand Corp. and McKinsey & Co conducted more than a dozen assessments. No one has told the public what should to be done and what these assessments cost the taxpayer.

“A sweeping independent review of the Department of Veterans Affairs health-care system made public Friday shows the multibillion-dollar agency has significant flaws, including a bloated bureaucracy, problems with leadership and a potentially unsustainable capital budget.”

All that was needed was a little common sense by an authorized executive to realize what the problems were and fix them. All the defects were reported previously.

The government did not need multiple high priced consultants to tell them their problems.

The Commission on Care was mandated by the Veterans Access, Choice and Accountability Act to create a comprehensive reform plan to congress and the VA in 2016.

How much is this going to cost taxpayers?

How long is it going to take?

“The report bears out collectively what I have seen individually, what I have seen in my role as chairman over the past nine months,” said Sen. Johnny Isakson (R., Ga.), chairman of the Senate Committee on Veterans’ Affairs. “There is a huge focus on some glaring deficiencies that need to be addressed.”

The VA needs a lot of common sense and less bureaucracy, not more bureaucracy.

“Mr. Isakson said the VA suffers especially from a system saddled with a number of different departments that can’t effectively talk with each other, as well as a number of vacancies in leadership positions that need to be filled.”

America never learns. Big government does not work. Americans are starting to believe it.

President Obama and Obamacare are leading us in the same direction. It is the path to failure.

We must wake up now and stop this.

 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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