The bureaucratization of academic medicine is interesting. Okay, it’s painful more than interesting, considering I’ve been working in teaching hospitals these past eight years after fellowship. There seems to be money for shiny glass building, marble lobbies and Starbuck-ian cafes, marketing departments, directors of diversity, and managers of this and that, but, oddly enough, not enough money for more staff.

I have recently been told that because of national fire protection agency rules, which we must follow to be accredited, I must sit in a microscope room, 10-12 hours a day, with the door closed. No windows in the room, no window in the door that must be shut, and only one way out is through the door which must remain closed. Meanwhile, the open plan lab next door, which is separated from me by a second fire door, is full of chemicals on benches and on worktops. And the techs sit right next to chemicals without fire retardant gear, don’t they? Look, I’m sure there is some perfectly valid reason for the rule, but for heaven’s sake! I feel like a veal in a cage!

We have the marketing department putting up signs and flatscreens running pro-hospital propaganda that would make a communist regime proud. I would be angry about it all, except that I am resigned, sheep-like, to all of it and am currently sitting and weeping quietly over the layers of administration. Just give in, just give in, just give in, says a voice in my head, but my heart says No! Sigh.

We docs who actually bill and make money are so terrible, aren’t we, with our complaints? Perhaps we could just fire all the docs and nurses and send the patients straight to the marketing department? They can sort it all out.

*I’m not actually weeping, of course :)

The problem is an information problem at heart. Bureaucrats lie to protect their budgets and threaten dire consequences that are not real. Free marketeers generally make exceptions to their love of the private sector for acts of fraud and other lies.

As an aside, pretty much all major US monuments are built with private labor and dollars and then donated to the government to maintain. It’s a US tradition I support heartily. I remember dropping a few dollars into a box to fund the WW II memorial a few years back.

Shannon Love – A website covers so much territory but yes, I agree that it would have to be something electronic. I think it would be much more useful to view it as a database with multiple data entry pathways. You could do phone trees for the low tech inclined and social networks for the trendy, plain web forms for those who prefer them and include BI analysis toolsets for the data nerds (and yes, I am a data nerd).

TF Vol – Optimist

Johnathan – The DoD got away with telling the Clinton administration that it took two weeks to fly helicopters from the FRG to Kosovo and that they needed multiple weeks of training after that before they were deployed for combat missions. Defying presidents isn’t just for the Parks Service. The CIA seems to have gotten a taste for it recently for instance and I don’t think anybody really believes that the politicians are fully in control of State or have been in decades.

Renminbi – The current opportunities for graft are so huge that a political party could have a multi-decade run in power based on the premise of reducing graft and abuse by hundreds of millions of dollars every year and throughout that run feed lustily on the opportunities for personal enrichment they haven’t quite gotten around to yet. I’m not talking about reformers who promise but don’t deliver but rather reformers who actually deliver more honest government with every Congress and who deserve re-election on that basis.

It’s the most stable shot at power either party has right now but both seem too stupid to assemble a winning party coalition to run, win power on the principle, and (most importantly) execute their promises faithfully. Gingrich Republicans came close but couldn’t hold on for very long.

Linc – You’re absolutely correct.

Fred Lapides – Please don’t take my post as an endorsement of the GOP right or wrong. I’ll vote in November but will likely leave the presidential ballot blank. Rather take it as an analysis that the GOP, when desperate, will often turn towards small government solutions and they won’t be more desperate than after a 2008 blowout during President Obama’s media honeymoon.

Of course, what happens is that the other uses of tax revenues do not get scrutiny, and the pressure lessens to drop or trim existing programs in order to pay for worthy new ones or improvements in more valuable programs.

The devil is in the details of course,but the point is that electoral politics is failing to protect us from “our” gov’t. There are better ways allow the exercise of civic responsibility.

I doubt that any Democratic administration would willingly give up such a useful political tool.

Probably the best time to do it is in the honeymoon phase of our next Democrat president, when the media’s in the tank and blowing kisses at the new administration.

I wouldn’t count on a Democrat president anytime in the near future.

A website might be the best way to do this. Set up a site to break down spending and let people and their representatives record their preferences long before any cuts need to be made. I would suggest a system in which every person (probably every elected official) has, say, a hundred points that they distribute across the various spending priorities in order to indicate the relative value they attach to each choice.

You could start the program out as an exercise in journalism. Just give politicians the chance to register their priorities. Do it long enough and it would become standard practice.

I am reading the Chicagoboyz, right? How can you get the government or public who tolerate the current behavior to ban something they don’t mind?

An aside, the Washington monument was built with private dollars and labor.