Archive for the 'Health Care' Category
Posted by Michael Kennedy on 21st July 2014 (All posts by Michael Kennedy)
Cash medical practice or, in the phrase favored by leftists critics, “Concierge Medicine,” seems to be growing.
Becker is shifting to a new style of practice, sometimes called concierge or retainer medicine. With the help of a company that has been helping physicians make such shifts for over 13 years, he will cease caring for a total of 2,500 patients and instead cut back to about 600. These patients will pay an annual fee of $1,650. In exchange, they will receive a two-hour annual visit with a complete physical exam, same-day appointments, 24-hour physician phone access, and personalized, web-based resources to promote wellness.
The article suggest that all these doctors choosing to drop insurance and Medicare are primary care. Many are but I know orthopedists and even general surgeons who are dropping all insurance.
The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness.
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Posted in Big Government, Bioethics, Crony Capitalism, Health Care, Medicine, Politics, Science | 23 Comments »
Posted by Trent Telenko on 10th July 2014 (All posts by Trent Telenko)
(NOTE — Update at the End of the Column)
One of the things that changes you, when you become a parent, is the body of knowledge you acquire to protect your spouse and children including things like knowledge of infectious diseases in public schools. In my case that meant looking at the NY Times saying the following: “…the administration has begun to send the expected 240,000 migrants and 52,000 unaccompanied minors who have crossed the border illegally in recent months in the Rio Grande Valley to cities around the county.” And at headlines for the open border crisis like this by Todd Starnes titled “Immigration crisis: Tuberculosis spreading at camps” which caused me to immediately free associate them with a pair of “Tuberculosis in Public School”, headlines, one local to North Texas in 2011 and the other very recently in California. See this 2011 Consumer Health Daily article from Denton Texas “TB Outbreaks in Texas Schools Show Disease Still a Threat – At least 100 people have tested positive for the respiratory ailment” and this 1 July 2014 article from the Sacramento Bee “Four more students test positive for tuberculosis at Grant High.”
As a Texas parent, this idea of TB positive illegal alien children released to illegal immigrant parents scares the heck out of me from the point of view of epidemiology. In the 1920s TB was the eighth leading cause of death for children 1-to-4 years old. Since then American public health has been so effective in preventing it that the USA no longer has any “herd immunity” to TB.
This “catch and release” illegal alien policy is horrible from the infectious disease point of view in that phlegm or aerosolized sputum that are contaminated with Mycobacterium tuberculosis are active biohazards that have long latent infection periods. This makes “exposure” very easy. The clinical definition of TB Exposure — which I found in a University of Vanderbilt student medical file PDF — is the following:
“A person is considered to be exposed if there is shared breathing space with someone with infectious pulmonary or laryngeal tuberculosis at a time when the infectious person is not wearing a mask and the other person is not wearing an N95 respirator. Usually a person has to be in close contact with someone with infectious tuberculosis for a long period of time to become infected; however, some people do become infected after short periods, especially if the contact is in a closed or poorly ventilated space.”
The Federal Government Hazmat protocol for dealing with suspected active TB cases is as follows:
1. Administrative controls
• “Develop policies and protocols to ensure the rapid identification, isolation, diagnostic evaluation and treatment of persons likely to have TB.”
2. Engineering controls
• Isolation and
• Negative pressure room ventilation
3.Personal protective equipment controls
• N95 personal respirator protection
Questions people and reporters need to be asking their local, state and federal elected officials regards the so-called “unattended child immigration crisis” include:
1. How many Border Patrol Agents, health workers or other support staff at these immigration processing centers have worn N95 respirators in treating symptomatic TB sufferers?
2. How many TB sufferers were also wearing masks?
3. Have those Border Patrol Agents, health workers or other support staff followed a rigorous TB decontamination protocol?
Whether people ask those questions or not, we are going to find out the answers soon, and not just in Texas. Testable anti-bodies to TB infection appear in two to 12 weeks for skin and blood tests and the incubation period for full blown active TB is six months to two(+) years.
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Posted in America 3.0, Americas, Big Government, Bioethics, Civil Liberties, Civil Society, Health Care, National Security | 76 Comments »
Posted by Jonathan on 7th July 2014 (All posts by Jonathan)
The short answer in many cases is “no”:
In one session, almost half the group of 160 gynaecologists responded that the woman’s chance of having cancer was nine in 10. Only 21% said that the figure was one in 10 – which is the correct answer. That’s a worse result than if the doctors had been answering at random.
The fact that 90% of women with breast cancer get a positive result from a mammogram doesn’t mean that 90% of women with positive results have breast cancer. The high false alarm rate, combined with the disease’s prevalence of 1%, means that roughly nine out of 10 women with a worrying mammogram don’t actually have breast cancer.
It’s a maths puzzle many of us would struggle with. That’s because, Gigerenzer says, setting probabilities out as percentages, although standard practice, is confusing. He campaigns for risks to be expressed using numbers of people instead, and if possible diagrams.
Graphic showing “false positives” in mammogram tests
Even so, Gigerenzer says, it’s surprising how few specialists understand the risk a woman with a positive mammogram result is facing – and worrying too. “We can only imagine how much anxiety those innumerate doctors instil in women,” he says. Research suggests that months after a mammogram false alarm, up to a quarter of women are still affected by the process on a daily basis.
Survival rates are another source of confusion for doctors, not to mention journalists, politicians and patients. These are not, as you might assume, simply the opposite of mortality rates – the proportion of the general population who die from a disease. They describe the health outcomes of people who have been diagnosed with a disease, over a period of time – often five years from the point of diagnosis. They don’t tell us about whether patients die from the disease afterwards.
The linked article is worth reading despite its implicit pro-NHS boosterism. See also this. The poor education in statistical analysis of doctors, lawyers, journalists and members of other influential groups in our society is a significant problem.
(Via Mangan RT by heartiste on Twitter.)
UPDATE: Gerd Gigerenzer’s Books
Posted in Book Notes, Health Care, Human Behavior, Medicine, Statistics | 7 Comments »
Posted by Michael Kennedy on 3rd July 2014 (All posts by Michael Kennedy)
I have been predicting this, especially since these polls.
Even the Washington Post has second thoughts.
Romney would hold a slight lead on President Obama if the 2012 election were replayed today, according to a new Washington Post-ABC News poll.
The poll of registered voters shows Romney at 49 percent and Obama at 45 percent in the rematch, a mirror image of Romney’s four-point (51-47) popular-vote loss in 2012.
Now, we have this.
What can I say except I told you so.
Will Romney be different from these other failed nominees? Could he defy the odds and make a comeback presidential bid capturing the GOP nomination after all the doubt, second-guessing and blame that accompany such a loss? According to the latest Quinnipiac poll, many Americans seem to think so—45 percent of voters said the United States would be better off today with Romney as president.
I donated more to the Romney campaign than I have in any other election and I was a volunteer for McCain in 2000.
I told you so. I think there is a case that the 2012 election was stolen.
The knowledge that the 1960 election was probably stolen helped Nixon in 1968. That and the failure of the Johnson Administration in Vietnam. Anyway, I have been predicting this for a while at Althouse and I can’t remember if I have posted this opinion here. Obama, with the time he has left, will make this more and more attractive. I thought we were doomed after 2012. I still think so but maybe I was wrong. The Megyn Kelly interviews with Bill Ayers might even help although she never got into the Ayers-Obama relationship.
I just hope we avoid the worst of the blowback from inept foreign policy before 2016.
More. This is amazing.
All this is weird, unprecedented. The president shows no sign—none—of being overwhelmingly concerned and anxious at his predicaments or challenges. Every president before him would have been. They’d be questioning what they’re doing wrong, changing tack. They’d be ordering frantic aides to meet and come up with what to change, how to change it, how to find find common ground not only with Congress but with the electorate.
Instead he seems disinterested, disengaged almost to the point of disembodied. He is fatalistic, passive, minimalist. He talks about hitting “singles” and “doubles” in foreign policy.
“The world seems to disappoint him,” says The New Yorker’s liberal and sympathetic editor, David Remnick.
Posted in Big Government, Civil Liberties, Crony Capitalism, Current Events, Elections, Health Care, Middle East, Obama, Politics, Polls, Predictions | 25 Comments »
Posted by Jay Manifold on 1st June 2014 (All posts by Jay Manifold)
Judging by what I see communicated by many of my longtime friends, there are a whole lot of confused people out there these days. Here is a helpful list for them:
- Only a small minority of projects, even in relatively successful organizations in highly competitive industries, deliver their promised scope, on time, within budget. A large majority are drastically scaled back, incur huge cost overruns, deliver years later than intended, or are canceled outright. Anything nefarious either fails or is publicized by whistle-blowers or investigators. There are no secret, vast criminal enterprises pulling the wool over the eyes of the populace, and the best-known entities in society, both public and private, can be astonishingly inept.
- Large publicly-funded initiatives, other than those intimately connected to the physical survival of the societies in which they are undertaken, are quite likely to be mainly for show, irrespective of their supposedly spectacular significance. The current American example is the ACA, which has not resulted (and almost certainly will not result) in either greater insurance coverage or lower costs, is notoriously not a fully government-operated, “single-payer” system, and has no pathway to lead to one. None of this matters; indeed, many of its provisions, if they ever go into effect, will do so only after the current Administration has departed from the scene. All that matters is that its perpetrators get to claim to have passed “historic” legislation ostensibly providing “universal” health care. For an example from an earlier generation, see the Space Shuttle, which was supposed to fly 50-60 times per year at $5.5 million per launch. The actual flight rate hovered around a tenth of what was promised, and each launch cost nearly a hundred times the original projection. Hilariously, President Obama is now being criticized for ending this, even though it was collapsing from its own weight and consisted mainly of workfare jobs in Republican congressional districts.
- Notwithstanding phenomena like the above, the United States is probably the most successful large-population country in the world due to its sheer realism, in particular the relative openness and process orientation of English common law, which (to quote myself) “rather than construct elegant theories and then shoehorn (or bludgeon) societies into an unchanging mold,” exhibits “a willingness to work with the world and human nature as it is.”
- Even ignoring the fantastic technological advances, quality of life in the US has improved immensely in the past two decades. Social pathologies have plummeted. The rates of some categories of crime are down 90%, to all-time recorded lows. There are now fewer abortions per capita than at the time of Roe v Wade. Probably three-quarters of Americans live in neighborhoods where violent crime is effectively nonexistent. And the worst labor market in 80 years has done nothing to reverse these trends.
- Large-scale, institutionalized technologies range from the very safe (electric-power generation [including nuclear] and transmission) to the so-safe-there-is-no-instance-of-recorded-harm (agricultural genetic engineering). The problem is that in much of the real (that is, Third) world, they are insufficiently available to provide the thoughtless, comfortable existence that pervades most of the West. Living “off the grid” / following a soi–disant “natural” lifestyle is a plaything of rich people who can slink away into town whenever they get tired of hewing wood and drawing water. Especially water with enterotoxigenic E. coli in it.
- Pharmaceutical companies are not trying to kill you, nor to provoke health crises to sell new drugs. They may in some instances be trying to convince you that your life depends on continuing to purchase their products, whether it actually does or not. Then again, so is the “health food” store down the street, and in all likelihood, what it’s pushing is far more dangerous.
- All religions are not equal. The general heuristic is to judge them by their effects, or at least by their efforts. Those prescribing global expansion through conquest and coercive displacement, and those (especially if they don’t refer to themselves as religions) prescribing the extermination of followers of other religions, are particularly problematic.
- Any conspiracy theory that mentions the Mossad, Rothschilds, etc, is every bit as viciously anti-Semitic as Mein Kampf and should be treated as such. Anyone expressing admiration for Marxist notions and personages is no better. Conspiracy theories involving the CIA quaintly ignore the NSA (which is ~6x larger) and, in any case, descend from Stalinist and Maoist propaganda during the early Cold War and the Korean War. Facile anger about the NSA, however, ignores its well-publicized activities with the analog wireline telecommunications of 30-40 years ago, as amply documented in Bamford’s The Puzzle Palace. The phenomena of Wikileaks and Snowden’s massive data theft are an existence proof that such activities can neither be kept secret nor have much influence on real-world events; as someone who read through the supposedly devastating Wikileaks cables remarked, “[American diplomats] sound like Canadians with better access.”
- No amount of “smart diplomacy” or supposed avoidance of provocation will protect a country from attack. Only a convincing ability to make an attack more trouble than it could possibly be worth can do that, and even such an ability may be insufficient to deter non-state actors and small groups. In combination with steadily declining costs of dual-use technologies, a more-or-less freelance WMD attack somewhere in the world seems inevitable. When it occurs, the greatest hazards to the immediate survivors will be 1) official overreaction, as by ordering the evacuation of a far larger area than was actually affected and 2) popular derangement, which in the worst-case scenario may create a conspiracy theory popular enough to put an extremist political movement in power, even in a large, democratic nation.
Commenters are encouraged to provide additional examples and corollaries.
Posted in Anglosphere, Anti-Americanism, Civil Society, Current Events, Energy & Power Generation, Health Care, History, Human Behavior, International Affairs, Management, Military Affairs, National Security, Organizational Analysis, Predictions, Religion, Society, Terrorism, USA, War and Peace | 17 Comments »
Posted by Michael Kennedy on 22nd May 2014 (All posts by Michael Kennedy)
The activities of the Obama administration have progressed into Mafia territory the past five years. I never thought things could change this fast but it seems I was wrong. The latest example ?
Soon after the US Government sold the last of its stake in General Motors, the company began to announce a huge number of recalls. These safety defects were known for years but unreported until the federal government sold its interests, at a huge loss of course.
Taxpayers, drivers, and investors who assumed the government would never fail to disclose rampant safety problems in a company it owned can rest easy, though. Instead of investigating fatally flawed GM components while the U.S. government was the company’s largest single owner, the NHTSA was busy harassing Toyota — one of GM’s top competitors — for an alleged malfunction that led to “unintended acceleration” in Toyota vehicles. Toyota was fined and eventually bullied into recalling 8 million vehicles over the issue.
Toyota is probably the safest, highest quality auto maker in the world. I drive one and have bought Toyotas for my daughter.
And what was the final result of the NHTSA investigation?
Many drivers may have confused the gas and brake pedals a problem that may account for “the vast majority” of the unintended acceleration incidents the agency investigated, NHTSA deputy administrator Ron Medford said at Tuesday’s NHTSA press briefing.
“What mostly happened was pedal misapplication where the driver stepped on the gas instead of the brake or in addition to the brake,” Medford said.
The Toyota cases were always about driver error, not safety of the auto. Only the trial lawyers and a complacent government permitted this raid on a company to proceed.
Is that the only case ?
Read the rest of this entry »
Posted in Big Government, Crony Capitalism, Current Events, Health Care, Morality and Philosphy, Obama, Politics | 87 Comments »
Posted by Jonathan on 9th March 2014 (All posts by Jonathan)
Went to a big street fair today. Great weather, big crowd. Here’s a picture of the Obamacare signup booth.
Posted in Health Care, Photos | 6 Comments »
Posted by Michael Kennedy on 4th February 2014 (All posts by Michael Kennedy)
I have believed for some time that we were entering another Depression. I have previously posted about it.
The Great Depression did not really get going until the Roosevelt Administration got its anti-business agenda enacted after 1932. The 1929 crash was a single event, much like the 2008 panic. It took major errors in economic policy to make matters worse. Some were made by Hoover, who was a “progressive” but they continued under Roosevelt.
I posted that statement earlier and it got a rather vigorous rebuttal. I still believe it, however. I think a depression is coming soon. What is more, I am not the only one. Or even only one of two.
The second article preceded the election of 2012 but is still valid.
When employment hit an air pocket in December, most analysts brushed off the dreadful jobs number as an anomaly, or a function of the weather. They chose to believe Ben Bernanke rather than their lying eyes. It’s hard to ignore a second signal that the U.S. economy is dead in the water, though: on Monday the Institute for Supply Management reported the steepest drop in manufacturing orders since December 1980:
In January, only 51% of manufacturers reported a rise in new orders, vs. 64% in December. Not only did the U.S. economy stop hiring in December, with just 74,000 workers added to payrolls; it stopped ordering new equipment. The drop in orders is something that only has occurred during recessions (denoted by the shaded blue portions of the chart). The Commerce Department earlier reported a sharp drop in December orders for durable goods. In current dollars, durable goods orders are unchanged from a year ago, which is to say they are lower after inflation.
So, the economy stopped hiring, even at the poor pace the past five years have seen, but business also stopped buying.
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Posted in Big Government, Britain, Business, Health Care, Obama, Politics, Taxes, Tea Party, Urban Issues | 33 Comments »
Posted by Michael Kennedy on 18th January 2014 (All posts by Michael Kennedy)
The CMS has a new contractor for Obamacare, not just the web site. The previous contractor, CGI Federal, has been replaced rather suddenly.
“Accenture, one of the world’s largest consulting firms, has extensive experience with computer systems on the state level and built California’s large new health-insurance exchange. But it has not done substantial work on any Health and Human Services Department program.
“The administration’s decision to end the contract with CGI reflects lingering unease over the performance of HealthCare.gov even as officials have touted recent improvements and the rising numbers of Americans who have used the marketplace to sign up for health coverage that took effect Jan. 1.”
CGI Federal is the company connected with Michelle Obama through her classmate, a fellow Princeton alumna.
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Posted in Big Government, Economics & Finance, Health Care, Management, Medicine, Politics | 18 Comments »
Posted by Sgt. Mom on 9th January 2014 (All posts by Sgt. Mom)
All during late November and December of last year, I began seeing internet discussions of the looming disaster that is Obamacare – and yes, I will hang that name on the so-called Affordable Care Act, also known as the un-Affordable Care Act. The man behind the desk in the Oval Office pursued this as his singular achievement; his legislative allies rammed it through over protest, and his media allies have viciously abused those who advised caution. So it is only fitting and fair that his name get attached to it at every opportunity, especially if it brings down his whole political machine in a spectacular fashion, rather like a slow-motion Hindenberg collapsing.
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Posted in Big Government, Deep Thoughts, Health Care | 47 Comments »
Posted by David Foster on 7th January 2014 (All posts by David Foster)
The “Affordable Care Act,” aka Obamacare, seems to be full of surprises. For example, it seems that many Americans are being forced onto Obamacare exchanges where most plans provide only local medical coverage…a bit of a problem for people who travel, change jobs, or have vacation homes. To take another example, this Washington Post article says Obamacare may make it impossible for people living in American territories (such as Guam and the Northern Mariana Islands) to purchase health insurance policies at all. “Unexpected!” results of Obamacare seem to be almost daily news.
These surprises especially strike those ordinary Americans who are the targeted users of Obamacare, of course…but also, they seem to strike many of the creators of the program. Some members of the government classes, of course, simply lied about Obamacare’s effects…first and foremost this is notoriously true of Obama himself. But I also feel sure that there are many among those CongressCreatures who voted for this 2000-page bill who have been genuinely surprised by some or many of its outcomes. It is simply not possible to clearly predict in advance the effects of a piece of legislation so all-encompassing, so verbose, and so quickly pushed through.
Rose Wilder Lane, still at that point a Communist, visited the Soviet Union in 1919. After she explained the benefits of central planning to a disbelieving village leader, he shook his head sadly and said:
It is too big – he said – too big. At the top, it is too small. It will not work. In Moscow there are only men, and man is not God. A man has only a man’s head, and one hundred heads together do not make one great big head. No. Only God can know Russia.
Indeed, one hundred or one thousand or ten thousand heads together in the form of CongressCreatures or health care bureaucrats did not suffice to make one great big head that would fully grasp the implications of Obamacare. Nancy Pelosi was sort of right when she said “But we have to pass the bill so that you can find out what is in it”…she should have carried it further and said: “We have to pass the bill so that we can find out what’s in it.”
It is precisely this difficulty in predicting the outcomes of sweeping change, on a society-wide scale, that makes such sweeping and radical change something to be usually avoided..and when indeed necessary, to be conducted with caution and careful forethought. British statesman and political philosopher Edmund Burke made this point eloquently and famously. Nothing could be more anti-Burkean than Obama’s statement on October 30, 2008: “We are five days away from fundamentally transforming the United States of America.”
After coming to realize that the defects of Communism are inherent and not just due to problems with one particular implementation of it, Rose Wilder Lane also became convinced that:
Centralized economic control over multitudes of human beings must therefore be continuous and perhaps superhumanly flexible, and it must be autocratic. It must be government by a swift flow of edicts issued in haste to catch up with events receding into the past before they can be reported, arranged, analyzed and considered, and it will be compelled to use compulsion. In the effort to succeed, it must become such minute and rigorous control of details of individual life as no people will accept without compulsion. It cannot be subject to the intermittent checks, reversals, and removals of men in power which majorities cause in republics.
Note how this comment ties in with the Obama administration’s tendency to adjust the healthcare insurance program via quick and arbitrary administrative rulemaking, rather than via the legislative process. RWL would say that this kind of behavior is inherent in a program intended to establish government control over vast swaths of society.
She also notes that:
Nobody can plan the actions of even a thousand living persons, separately. Anyone attempting to control millions must divide them into classes, and make a plan applying to these classes. But these classes do not exist. No two persons are alike. No two are in the same circumstances; no two have the same abilities; beyond getting the barest necessities of life, no two have the same desires.Therefore the men who try to enforce, in real life, a planned economy that is their theory, come up against the infinite diversity of human beings. The most slavish multitude of men that was ever called “demos” or “labor” or “capital” or”agriculture” or “the masses,” actually are men; they are not sheep. Naturally, by their human nature, they escape in all directions from regulations applying to non-existent classes. It is necessary to increase the number of men who supervise their actions. Then (for officials are human, too) it is necessary that more men supervise the supervisors.
…and discusses the temptations of power to a leader who believes in expansionist government:
If he wants to do good (as he sees good) to the citizens, he needs more power. If he wants to be re-elected, he needs more power to use for his party. If he wants money, he needs more power; he can always sell it to some eager buyer. If he wants publicity, flattery, more self-importance, he needs more power, to satisfy clamoring reformers who can give him flattering publicity.
Posted in Civil Society, Health Care, Law, Leftism, Obama, Political Philosophy, USA | 11 Comments »
Posted by Michael Kennedy on 2nd January 2014 (All posts by Michael Kennedy)
David has a good idea. I often read the archives of my personal blog to see how I did in forecasting the future or understanding the present. A major concern of mine is, of course, health care and what is happening. When I retired from surgery after my own back surgery, I spent a year at Dartmouth Medical School’s center for study of health care. My purpose was to indulge an old hobby. How do we measure quality in health care ? I had served for years on the board of a company called California Medical Review, Inc. It was the official Medicare review organization for California. For a while I was the chair of the Data Committee. It seems to have gone downhill since I was there. First, it changed its name in an attempt to get more business from private sources. Then it lost the Medicare contract.
Lumetra, which lost a huge Medicare contract last November, is changing its name and its business model as it seeks to replace more than $20 million in lost revenue.
The San Francisco-based nonprofit’s revenue will shrink this year from $28 million last fiscal year, ending in March 2009, to a projected $4.5 million, CEO Linda Sawyer told the Business Times early this week.
That’s in large part because it’s no longer a Medicare quality improvement contractor, formerly its main line of work. And in fact, the 25-year-old company’s revenue has been plummeting since fiscal 2007, when it hit $47 million.
I see no sign that it is involved with Obamacare which is being run from Washington with a state organization that seems no better run than the parent organization.
Beginning Jan. 1, 2015, the Affordable Care Act no longer will provide federal grants to fund state health exchanges. In addition, California law prohibits using the state’s general fund to pay for the exchange.
Anyway, for what it is worth, here are the links to the 2013 health posts.
The Lost Boys
Alternatives to Obamacare.
Why the Obamacare Site Isn’t Working.
Where Healthcare May be Going.
Conservatives Invented the Mandate; say the Democrats.
A Critical Insight.
A Rolling Catastrophe.
Why Health Care is in Trouble.
Where Do We Go Now ?
Building the Airplane During Takeoff.
Posted in Blogging, Current Events, Health Care, Medicine, Obama, Politics, Systems Analysis | 17 Comments »
Posted by David Foster on 22nd December 2013 (All posts by David Foster)
President Obama has been unwilling to admit that the problems with the Obamacare roll-out might suggest that he needs to work on improving his management skills. Instead, he has chosen to blame the complexities of government bureaucracy, and in particular the complexities of the government procurement process–all matters that have seemed to be rather surprising to him–and this view has predictably been echoed by some in the pundit class.
I have several thoughts on this matter:
1) It is not yet clear to what extent the Obamacare systems problems are a function of too much bureaucracy in the procurement process versus too little bureaucracy in that process as employed in this specific case. In particular, were Serco and CGI and other key contractors selected based on the robot-like processes of the Federal procurement system…or was heavy political influence involved? I don’t think we know yet.
2) A good workman understands the limitations of his tools and materials. We wouldn’t think much of a civil engineer who designed a high-traffic-carrying bridge without paying close attention to the load-bearing characteristics of the steel girders and cables used; nor would we think much of an architect who designed a house in which a family was investing much of their financial net worth without considering the weather resistance of the wood and other materials he was specifying. Shouldn’t Obama, before embarking on a plan to greatly increase the Federal Government’s role in healthcare, have seriously considered the characteristics and limitations of the tools and materials that he was using–the Federal agencies and their policies and procedures–for this purpose? He stands convicted out of his own mouth for not performing this basic level of due diligence.
3) Whatever the encumbrances of the Federal bureaucracy–and yes, we all know they are significant–nothing prevented Obama from taking a more serious and responsible executive role in supervising the roll-out, and/or putting effective people in key leadership positions. Can there be any doubt that if a person of the quality of General Bernard Schriever, for example, had been put in control of the technology and paperwork process implementation, the odds of success would have been considerably better?
4) Most important: Obama and his media/academic sycophants refuse to understand the inevitable limitation of government micromanagement. I’ve previously quoted Peter Drucker:
Whether government is “a government of laws” or a “government of men” is debatable. But every government is, by definition, a “government of paper forms.” This means, inevitably, high cost. For “control” of the last 10 per cent of any phenomenon always costs more than control of the first 90 per cent. If control tries to account for everything, it becomes prohibitively expensive. Yet this is what government is always expected to do.
The reason is not just “bureaucracy” and red tape; it is a much sounder one. A “little dishonesty” in government is a corrosive disease. It rapidly spreads to infect the whole body politic. Yet the temptation to dishonesty is always great. People of modest means and dependent on a salary handle very large public sums. People of modest position dispose of power and award contracts and privileges of tremendous importance to other people–construction jobs, radio channels, air routes, zoning laws, building codes, and so on. To fear corruption in government is not irrational.
This means, however, that government “bureaucracy”— and its consequent high costs—cannot be eliminated. Any government that is not a “government of forms” degenerates rapidly into a mutual looting society.
(I’m confident Professor Drucker would agree that whether the forms are paper or electronic makes no difference at all in this context.)
As I also noted earlier: the expansion of government into all aspects of human life leads to increasing inefficiency–while the increasing frustration with bureaucracy results in a widespread demand to “make government more responsive” by giving more discretionary authority to administrators and to their political superiors. This is exactly what we are seeing with Obamacare, with the emphasis at present being on an increase of discretionary authority for the political superiors of the administrators. This, in turn, must result in a government which is not only a looting society (Obamacare waivers or special privileges for politically-well-connected groups, for example) but increasingly a tyranny. Yet at the same time, there will still be enough baroque proceduralization (selectively enforced) to ensure high levels of inefficiency and very high government administrative costs. And the discretionary authority–the movement away from a Government of Laws and toward a Government of Men–must create widespread uncertainty and, consequently, equally widespread economic damage.
Posted in Health Care, Management, Obama, Tech | 13 Comments »
Posted by TM Lutas on 14th December 2013 (All posts by TM Lutas)
People signing up for Obamacare are being robbed by the government. This time it’s not metaphorically, like when your perfectly satisfactory insurance plan is made illegal and all the compliant plans are more expensive and have worse terms but literally. People are having their accounts debited improperly during the Christmas season. And because it is being done by the government, there is little recourse to sue due to sovereign immunity and, of course, those most injured haven’t the money to hire representation anyway. I think Pope Francis calls it ‘despoliation of the poor’.
Double debits, wrong day debits, wrong amount debits, these are all standard hazards with any sort of Electronic Funds Transfer (ETF) system. There’s nothing particularly new about these issues. It’s all part of the back end errors that those dastardly Republicans have been hyperventilating about and Democrats have been pooh poohing for weeks now.
You never know when Tuttle will turn into Buttle in one of these systems. But what’s in a name?
Cross posted: Flit-TM
Posted in Big Government, Health Care, Obama, Video | 20 Comments »
Posted by Jonathan on 22nd November 2013 (All posts by Jonathan)
A great post by J. E. Dyer:
1. The problem with Obamacare is that it fundamentally changes the relationship of government to the people. The change is wholly malign. There is no way to operate the Obamacare system and also force the government to respect the people’s rights. Obamacare will, at every step, increase the risk at which government holds our rights.
We’re already seeing that with the roll-out, which has promptly violated the president’s best-known and most categorical promises – an indication of his complete lack of respect for us – as well as the people’s rights to decide what to do with their own property (in this case, their earnings), and to execute private contracts according to their own preferences.
What matters about Obamacare is that it has forced so many people to do so many things involuntarily. It will continue to do so. Obamacare is about government force, about limiting people’s options, and about constraining the people to do or not do certain things. That’s what government is about, which is why it’s what Obamacare is about. Government is incapable of being about anything else.
The public debate right now treats the Obamacare fiasco as if the central proposition is that taking over one-sixth of the economy is a technological challenge. The reality that matters is that government taking over the network of human decisions involved in “health care” is a moral outrage. Doing that is applying the model of regulatory force to a vast complex of human questions that have no universal, “right” answers. We might as well let the government tell us what to eat, what to wear, where to live, and what God to believe in – and if Obamacare stands, our government will eventually do just that.
Quite frankly, I think the advice to Republicans to simply stand silent and “let Obamacare implode” is foolish. There is no hope of Obamacare imploding. It’s not a malformed bomb, governed by physical principles. It’s a man-made political arrangement. Its defenders will keep moving the goalposts and changing the rules to keep it on the field. It will get all the overtime it needs. The only way to defeat Obamacare is to actually counter it with a plan and a principled argument.
Read the whole thing.
Posted in Big Government, Health Care, Medicine, Obama | 2 Comments »
Posted by Jonathan on 22nd November 2013 (All posts by Jonathan)
It has taken a long time, but the price of hearing aids is in the process of falling dramatically. How has this happened? Technological innovation, of course, but there is more. There’s no shortage of technological innovation in U.S. health care. However, because third-party payers, that is, health insurers and governments, determine prices, there is no mechanism for customers to signal value to providers.
This is not the case for hearing aids: Although some states have mandated insurance coverage for hearing aids, this is usually limited to disabled children. The big market for hearing aids is seniors, and Medicare does not cover hearing aids.
This is another case of a phenomenon observed elsewhere by NCPA Senior Fellow Devon Herrick: Where patients pay directly for medical care, prices fall like they do in every other market.
(Via Leif Smith on Twitter.)
Posted in Business, Economics & Finance, Health Care, Medicine | Comments Off
Posted by Michael Kennedy on 19th November 2013 (All posts by Michael Kennedy)
UPDATE: The Wall Street Journal on how to fix the Obamacare crisis.
What can be done is Congress creating a new option in the form of a national health insurance charter under which insurers could design new low-cost policies free of mandated benefits imposed by ObamaCare and the 50 states that many of those losing their individual policies today surely would find attractive.
What’s the first thing the new nationally chartered insurers would do? Rush out cheap, high-deductible policies, allaying some of the resentment that the ObamaCare mandate provokes among the young, healthy and footloose affluent.
These folks could buy the minimalist coverage that (for various reasons) makes sense for them. They wouldn’t be forced to buy excessive coverage they don’t need to subsidize the old and sick.
Who knows ? Maybe Jenkins reads this blog. It’s so obvious that the solution should be apparent even to Democrats.
We are now learning that a large share of the Obamacare structure is still unbuilt. This is not the website but the guts of the system.
The revelation came out of questioning of Mr. Chao by Rep. Cory Gardner (R., Colo.). Gardner was trying to figure out how much of the IT infrastructure around the federal insurance exchange had been completed. “Well, how much do we have to build today, still? What do we need to build? 50 percent? 40 percent? 30 percent?” Chao replied, “I think it’s just an approximation—we’re probably sitting between 60 and 70 percent because we still have to build…”
Gardner replied, incredulously, “Wait, 60 or 70 percent that needs to be built, still?” Chao did not contradict Gardner, adding, “because we still have to build the payment systems to make payments to insurers in January.”
This is the guy who is the chief IT guy for CMS.
If the ability to pay the insurance companies is not yet written, how can anybody sign up ?
Gardner, a fourth time: “But the entire system is 60 to 70 percent away from being complete.” Chao: “There’s the back office systems, the accounting systems, the payment systems…they still need to be done.”
Gardner asked a fifth time: “Of those 60 to 70 percent of systems that are still being built, how are they going to be tested?”
The answer was the same way the rest was tested.
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Posted in Big Government, Health Care, Medicine, Obama, Politics, Systems Analysis | 8 Comments »
Posted by Michael Kennedy on 13th November 2013 (All posts by Michael Kennedy)
I don’t want to wear out my welcome with posts but this is a topic that has interested me for many years. When I retired from practice, I spent a year at Dartmouth trying to learn how we can improve health care delivery and reduce cost without reducing quality.
The Obamacare web site now has lost its happy photo of the Obamacare girl. The fact that she is a non-citizen seems appropriate. The web site is supposed to be fixed by November 30. Will that happen ? Well, maybe not.
On Friday, the man tasked with the digital fixes said the site “remains a long way from where it needs to be” as more and more problems emerge.
“As we put new fixes in, volume is increasing, exposing new storage capacity and software application issues,” Jeff Zients told reporters on a conference call.
And at Tuesday’s White House Press Briefing, Press Secretary Jay Carney again said there was “more work to be done” on repairing HealthCare.gov.
Carney, along with Zients and other administration officials, have repeatedly said the November 30 deadline is to get the health care website working for a “vast majority” of Americans looking to enroll in the Obamacare exchanges.
So, what happens December 2, the Monday after the “glitches” are fixed ? First, they won’t be fixed. The contractor that designed the program, not just the web site, has a terrible record.
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Posted in Advertising, Big Government, Civil Society, Economics & Finance, Health Care, Leftism, Medicine, Obama, Politics | 11 Comments »
Posted by Dan from Madison on 13th November 2013 (All posts by Dan from Madison)
I see today Diane Feinstein is ruffling her cankles and saying that she wants to force insurance companies to re-adopt programs that they were forced to cancel due to ZeroCare ™.
News flash Diane – IT’S TOO LATE.
Tens of thousands of small business owners like myself (and individuals and other entities) were forced to sign up to new coverage because of time constraints. Our (great) old policy was cancelled, our agents (and Blue Cross) couldn’t get to us with new policies in any sort of timely fashion because they couldn’t figure out what was legal, and what wasn’t. A few weeks ago we had a choice – sign for “this new policy” – with a dramatic price increase, or cut everyone loose to the exchanges (that don’t work) and provide them some sort of stipend.
We can’t just flip the switch back and forth. The real world doesn’t work this way. Ah, who am I kidding. They don’t exist in the real world.
Posted in Health Care, Obama | 11 Comments »
Posted by Jonathan on 12th November 2013 (All posts by Jonathan)
Listening to Rush today. He is brilliant on politics but not as good on economics.
He was advocating self-insurance for small businesses and individuals, in response to the Obamacare fiasco. He mentioned as an example that he had decided to self-insure a building (I think his home near a Florida beach) in response to his property insurer’s insistence on an extremely high deductible. He also said that he self-insures for medical costs.
Two problems with his analysis. One, property insurance covers buildings and building contents, so liability is easily estimated and is capped at replacement cost. Unlike with medical care there is no possibility of very large, unplanned expenses. Two, Rush is personally wealthy and can afford to pay any medical expenses out of pocket. For these reasons his argument has limited applicability for most people, who buy health insurance precisely because they would be unable to pay an outlier medical bill without experiencing significant hardship. The same point applies to many small businesses as well. These groups thus need real insurance to cover outlier medical expenses. A self-insurance quick-fix would be inadequate.
Posted in Business, Economics & Finance, Health Care, Obama | 6 Comments »
Posted by David Foster on 10th November 2013 (All posts by David Foster)
Over at Sister Toldjah, Phineas cites an email which notes:
Putting things in perspective: March 21st 2010 to October 1 2013 is 3 years, 6 months, 10 days. December 7, 1941 to May 8, 1945 is 3 years, 5 months, 1 day. What this means is that in the time we were attacked at Pearl Harbor to the day Germany surrendered is not enough time for this progressive federal government to build a working webpage. Mobilization of millions, building tens of thousands of tanks, planes, jeeps, subs, cruisers, destroyers, torpedoes, millions upon millions of guns, bombs, ammo, etc. Turning the tide in North Africa, Invading Italy, D-Day, Battle of the Bulge, Race to Berlin – all while we were also fighting the Japanese in the Pacific!! And in that amount of time – this administration can’t build a working webpage.
To be fair, the Obamacare support system is more than just a “webpage”…it also encompasses various back-end information-exchange systems. Still, it is a system that did not require the development of any truly new technologies or any conceptual breakthroughs in the use of existing technologies. Compared to any of a large number of WWII technology, manufacturing, and logistics efforts…proximity-fused ammunition, airborne radar, computer-based codebreaking, mass-production of airplanes and ships, the petroleum pipeline under the English Channel…the Obamacare support system is a very small thing indeed.
History and experience teach us that large, complex, time-critical programs only get done successfully when they are run by individuals who are tough-minded, possessed of practical wisdom, and willing to put their careers on the line to accomplish the goal…and when higher authority is willing to delegate sufficient scope and empowerment to such leaders. A couple of years ago, I wrote about one example of such a leader: General Bernard Schriever, who ran USAF ballistic missile programs.
In order to achieve his goal of delivering Atlas and other missile programs in the required time frames, General Schriever found it necessary to break a lot of china. For example, when Secretary of the Air Force Harold Talbott, ordered him to relocate certain missile facilities from the west cost to the midwest (supposedly based on industrial dispersion for survivability, but actually probably driven by political factors) Schreiver flatly refused, citing his “prior and overriding orders” to get the program done in the shortest feasible time. By then a general, Schriever stuck by his position on this even when Talbott threatened him that “Before this meeting is over, General, there’s going to be one more colonel in the Air Force!”
I don’t think people with strength of character like that of Bernard Schriever do very well in the Obama administration or that they remain with it for very long. A man who can say, as Obama did, “I think that I’m a better speechwriter than my speechwriters. I know more about policies on any particular issue than my policy directors. And I’ll tell you right now that I’m gonna think I’m a better political director than my political director” is a very small man. Small men tend to hire and retain only other small men and women.
And small men and women don’t run large and complex projects effectively.
Posted in Aviation, Health Care, History, Management, Obama, USA | 19 Comments »
Posted by Michael Kennedy on 8th November 2013 (All posts by Michael Kennedy)
Our health care system has been built up over the years in a jury-rigged, ramshackle fashion. Before World War II, there was very little health insurance and what there was often was the product of labor union contracts. The early years were concerned with accident insurance and workers compensation laws.
The American life insurance system was established in the mid-1700s. The earliest forms of health insurance, however, did not emerge until 1850, when the Franklin Health Assurance Company of Massachusetts began providing accident insurance, to cover injuries related to railroad and steamboat travel. From this, sickness insurance covering all kinds of illnesses and injuries soon evolved, but the first modern health insurance plans were not formed until 1930.
The Baylor program for school teachers was the first in 1929.
Medical insurance took stride in 1929 when Dr. Justin Ford Kimball, an administrator at Baylor University Hospital in Dallas, Texas, realized that many schoolteachers were not paying their medical bills. In response to this problem, he developed the Baylor Plan – teachers were to pay 50 cents per month in exchange for the guarantee that they could receive medical services for up to 21 days of any one year.
In those days, the concern was lost wages more than hospital care.
In 1939, the American Hospital Association (AHA) first used the name Blue Cross to designate health care plans that met their standards. These plans merged to form Blue Cross under the AHA in 1960. Considered nonprofit organizations, the Blue Cross plans were exempted from paying taxes, enabling them to maintain low premiums. Pre-paid plans covering physician and surgeon services, including the California Physicians’ Service in 1939, also emerged around this time. These physician-sponsored plans combined into Blue Shield in 1946 and Blue Cross and Blue Shield merged into one company in 1971.
The modern insurance plans were very recent in origin. I was there for much of it. The commercial insurers fought the status of Blue Cross, which was not required to have reserves. Blue Cross asserted that it promised hospital care, not payment, so reserves were not necessary.
The 1940s and 1950s also saw the proliferation of employee benefit plans, and the included health insurance packages became more and more comprehensive as strong unions negotiated for additional benefits. During the Second World War, companies competing for labor had limited ability to use wages to attract employees due to wartime wage controls, so they began to compete through health insurance packages. The companies’ healthcare expenses were exempted from income tax, and the resulting trend is largely responsible for the workplace’s present role as the main supplier of health insurance.
The war produced much of this as wage limitations were in force but fringe benefits, like health insurance, were permitted. A lot of this history is contained in Paul Starr’s book The Social Transformation of American Medicine.
From the first, commercial insurers focused on employer plans while Blue Cross and Blue Shield (which was founded by the California Medical Association to pay doctor bills) were individual plans.
In 1954, Social Security coverage included disability benefits for the first time, and in 1965, Medicare and Medicaid programs were introduced, in part because of the Democratic majority in Congress. In the 1970s and 1980s, more expensive medical technology and flaws in the health care system led to higher costs for health insurance companies. Responding to higher costs, employee benefit plans changed into managed care plans, and Health Maintenance Organizations (HMOs) emerged. Managed care plans are unique in that they involve a particular network of healthcare providers that have been verified for healthcare quality and that have agreements with the insurer about price and related issues. HMOs were originally primarily nonprofit, but they were quickly replaced by commercial interests, and managed care only succeeded in temporarily slowing the growth of healthcare costs.
Two major changes came in the 1970s. In 1978, the federal government established what were called Professional Standards Review Organizations or PSRO. All doctors had to receive training in how to do these reviews and it was immediately apparent that cost was the only consideration, not quality of care.
I decided to educate myself and took a course from an organization called “The American Board of Quality Assurance and Utilization Review Physicians. I took the exam and passed, then attended the annual meeting. This was about 1986. People I met at that meeting informed me that the exams were graded by throwing them up in the air. Any that landed balancing on one edge were flunked. Nonetheless, the experience was valuable because I could see what was coming.
I was president of the Orange County Medical Association that year and had served for eight years on the Commission on Legislation of the CMA, now called The Council on Legislation. This gave me an opportunity to meet many legislators, many state level and some federal. The impression they made on me was that few knew anything about medicine and most were not very intelligent.
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Posted in Big Government, Book Notes, Current Events, France, Germany, Health Care, Medicine, Politics | 19 Comments »
Posted by Michael Kennedy on 4th November 2013 (All posts by Michael Kennedy)
Obamacare debuted on October 1. It is now November 4 and the mess is worse. I have been posting about it, here, and here, and here, and even here.
The political left is trying very hard as can be seen here.
It’s kind of complicated so I will summarize. You are screwed !
There are accusations that insurance companies are using this to drop high risk subscribers. Maybe that is true but it is the consequence of ignorant people designing Obamacare. Did these guys ever set up a new business ? As Casey Stengel once said to the Mets , “”Can’t anybody here play this game?”
I guess not.
The New York Times has done what it can.
We are also told that “in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were. Some had deductibles as high as $10,000 or $25,000 and required large co-pays after that, and some didn’t cover hospital care.” Never mind that we have seen cancellations of insurance policies with deductibles much lower, and customers forced to purchase replacement policies with higher deductibles, and with premium increases of 100%, if not higher.
Then there is this argument.
Why can’t people opt out of mental health coverage if there is not a reasonable chance that they will need that coverage? Why can’t they get mental health coverage when it is needed? After all, pre-existing conditions can no longer be denied, so in the event that mental health coverage is needed down the line, it can be obtained and the insurance companies cannot deny people who already have pre-existing mental health conditions. The Times assures us that over-coverage–and the high premiums that come with it–is “one price of moving toward universal coverage with comprehensive benefits.” They don’t explain why having unnecessary coverage is a step towards social justice, but as we saw from the beginning of this intelligence-insulting, repulsively dishonest op-ed, the New York Times is less about explaining, and more about covering up a disastrous rollout with disastrous policy consequences for the country.
Peggy Noonan, who has frustrated me with her obtuseness at times, gets it now.
Politically where are we right now, at this moment?
We have a huge piece of U.S. economic and social change that debuted a month ago as a program. The program dealt with something personal, even intimate: your health, the care of your body, the medicines you choose to take or procedures you get. It was hugely controversial from day one. It took all the political oxygen from the room. It failed to garner even one vote from the opposition when it was passed. It gave rise to a significant opposition movement, the town hall uprisings, which later produced the tea party. It caused unrest. In fact, it seemed not to answer a problem but cause it. I called ObamaCare, at the time of its passage, a catastrophic victory—one won at too great cost, with too much political bloodshed, and at the end what would you get? Barren terrain. A thing not worth fighting for.
So the program debuts and it’s a resounding, famous, fantastical flop. The first weeks of the news coverage are about how the websites don’t work, can you believe we paid for this, do you believe they had more than three years and produced this public joke of a program, this embarrassment?
She assumed that it wasn’t worth it if it worked !
The problem now is not the delivery system of the program, it’s the program itself. Not the computer screen but what’s inside the program. This is something you can’t get the IT guy in to fix.
They said if you liked your insurance you could keep your insurance—but that’s not true. It was never true! They said if you liked your doctor you could keep your doctor—but that’s not true. It was never true! They said they would cover everyone who needed it, and instead people who had coverage are losing it—millions of them! They said they would make insurance less expensive—but it’s more expensive! Premium shock, deductible shock. They said don’t worry, your health information will be secure, but instead the whole setup looks like a hacker’s holiday. Bad guys are apparently already going for your private information.
This is the worst that could be imagined.
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Posted in Big Government, Bioethics, Civil Society, Current Events, Health Care, Leftism, Medicine, Politics | 20 Comments »
Posted by David Foster on 2nd November 2013 (All posts by David Foster)
…said Richard Nixon, famously. Comes now Joe Biden, with “I am not a geek.” Specifically, in responding to questions about the problems with the Obamacare website and its supporting systems, Biden said:
“Neither (the president) or I are technology geeks and we assumed that it was up and ready to run.”
I don’t think the main problems with this implementation have to do with a lack of geekitude–most likely, there are many quite competent software developers working on this project–but rather with a lack of effective management. (And if there is a shortage of competent developers on the project, well, that’s a management issue, too, isn’t it.)
Real managers, real executives, don’t assume that important things will be ready when they’re supposed to be ready, and they aren’t satisfied with superficial answers to superficial questions, either. These effective leaders are people who have developed effective questioning skills so they can find out what is really going on. They establish open, non-fear-based organizational cultures so that people with concerns feel able to bring them forward. As I noted in my post about Benghazi (excusing failure by pleading incompetence), it is the responsiblity of an executive to establish an information and decision-flow architecture…including clear assignment of responsibilities…to ensure that the right things are seen and acted upon by the right people at the right time. Failure to do this..and to maintain and tune the system over time…will predictably result in catastrophes.
Later in the interview with Biden, the Vice President also said he didn’t know the specifics of why the website isn’t working, but that he was told the platform “is fine, but they have to change an awful lot of the inputs.”
“Look, all I know is they talk about 50,000 lines of this and this, I don’t know the technical reasons,” Biden said.
”So I don’t know, I wish I could tell you, that’s why I became a lawyer,”
A pretty flippant response to a serious situation. Slow Joe might not be able to understand the technical reasons for the failure, but he should be able–if he were competent at his job–to investigate and understand the management reasons for the failure.
Some of the questions that come to mind about this debacle are: How were the contractors selected? Why was it decided to have the government (CMS) act as prime contractor, rather than choosing an external company for that role? What do the contracts with the outside contractors actually specify, in terms of deliverables? What remedies are provided in the contracts for failures in delivery? If these remedies are inadequate, why did the government not require that they be more stringent? What coordination vehicles were there between the government group writing and interpreting the Obamacare regulations and the separate group that was attempting to act as prime contractor? Was there a single individual in charge? What project scheduling and tracking methods were employed throughout this effort?
These are not issues that are specific to software technology–the above questions are ones that any good executive, whether his background is in construction or in theater or in wholesale distribution, would understand that he should ask.
A United States President is not elected as a philosopher king; he is elected to run the executive departments of government and to faithfully execute the laws passed by Congress. The members of the present administration have repeatedly demonstrated their utter incompetence to perform these tasks.
An administration that seeks endless expansion of government’s role–but is at the same time completely incompetent at carrying out basic executive tasks–will drive expanding circles of chaos throughout ever-broader reaches of American society and the American economy.
Posted in Big Government, Health Care, Management, Tech | 23 Comments »