Stanley Feld M.D.,FACP,MACE
President Obama finally admitted that we are at war with terrorists. He said there are problems in the massive intelligence bureaucracy.
It “failed to connect the dots of intelligence.” If the agencies were coordinated Umar Farouk Abdulmutallab, a known terrorist, who paid cash for his ticket, did not carry luggage and did not have a proper visa would not have been permitted to board the plane to Detroit on Christmas Day.
It was not a failure to connect the dots. There are systems defects in the bureaucracy. The intramural politics of bureaucracies prevents important information from moving up the food chain.
Robert Baer makes this point clear in his book “See No Evil 1988”. The CIA does not have agents in the field that understand local politics.
The author, working in the Counter-Terrorism Center when it was just starting out, has an extremely important story to tell and every American needs to pay attention. Why?
“Because his account of how we have no assets that are useful against terrorism. There are four other stories within this excellent book, all dealing with infirmed bureaucracies.”
The administration’s response to the potential terrorist attack demonstrates Robert Baer point.
“The National Counterterrorism Center’s NCTC and CIA—have a role to play in conducting (and a responsibility to carry out) all-source analysis to identify operatives and uncover specific plots like the attempted December 25 attack. . . .”
The agencies were not coordinated and missed the obvious terrorist.
How does this relate to the Healthcare Reform debate?
The Democrats in congress and President Obama’s administration are about to pass a terrible healthcare reform bill. The bill misses the obvious. An example of an ineffective bureaucratic agency is the Healthy People Project
The goal of healthcare reform should be to help Americans receive effective healthcare. I have contended that increasing bureaucracy and the cost of maintaining a bureaucracy does not deliver better healthcare or make Americans healthier. President Obama’s healthcare bill expands government bureaucracy.
“ Worse, all of this bureaucracy is packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony”
Real repair of the healthcare system is missing:
Real healthcare education,
Real cultural changes in eating and self responsibility,
Real enforceable food production legislation,
Real tort reform,
Real healthcare insurance reform,
Real chronic disease management systems education for both physicians and patients.
These real changes will help decrease the cost of medical care.
Unfortunately none of these changes are in President Obama’s healthcare reform bill. Instead there are 118 new boards, commissions, and programs doing its thing to generate reports and pilot studies.
Atul Gawande in a recent New Yorker article pointed out that President Obama’s healthcare reform bill offers pilot studies.
“So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.
Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude.”
I have pointed out in the past that poorly designed pilot studies are a waste of money.
Dr. Gawande tries to illustrate the potential value of a pilot study and justifies President Obama’s healthcare reform bill.
The federal government published preliminary results of the Healthy People Project health goals for the nation from 2000 to 2010. Its healthcare goals have not been achieved.
“There are more obese Americans than a decade ago and not fewer. We eat more salt and fat, not less. More of us have high blood pressure and diabetes. More of our children have untreated tooth decay, obesity and diabetes.”
The lack of control of these diseases result in their complications.
"We need to strike a balance of setting targets that are achievable and also ask the country to reach," said Dr. Howard Koh, the federal health official who oversees the Healthy People project. "That’s a balance that’s sometimes a challenge to strike."
This is bureaucratic jargon. It is one thing to ask the country to achieve these goals. It is another thing to get people to change their habits. The Healthy People Project has been in existence since 1980.
After more than 30 years, the goals aren’t well known to the public and only a modest number have been met.
“About 41 percent of the 1990 measurable goals were achieved. For the 2000 goals, it was just 24 percent. Worse, the nation actually retreated from about 23 percent of the goals.”
I would say this expensive bureaucratic pilot study was a failure.
Healthy People 2010 called for the percentage of adults who are obese to drop to 15 percent. In 2000, 25% of all adults were obese. Now, about 34 percent of adults are obese. Twenty eight percent of Americans had hypertension in 2000. Today 29% of Adult Americans have hypertension. The Projects goal was to reduce hypertension to 16%.
“To many health officials, simply making progress is a victory. An analysis of 635 of the nearly 1,000 targets for the past decade shows only 117 goals have been met. But progress was made toward another 332. In other words, there was improvement in 70 percent of the measures.
"That’s evidence of a healthier nation," Koh said.”
You have got to be kidding!! Is this what we want from President Obama’s Healthcare Reform bill, 118 new bureaucratic agencies? There is something wrong here.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.