Wednesday, July 21, 2010

Reasoning Behind Growing Health Care Bureaucracy

Everybody complains about the growing health care bureaucracy, but few analyze it and tell the reasons why it exists. That’s why we should be grateful to David Brooks, NYT columnist, for explaining what is going on.

Here are a few excerpts from a July 19 column ”The Technocracy Boom” on the bureaucratic mindset that has seized the imagination of the ruling party elite. The mindset is metastasizing in Washington. It is sucking the lifeblood and joy out of American business and health care enterprises. It says that those at the top can dictate what goes on at the bottom.

The italicized sentences are my doing. They explain the reasoning behind the new bureaucracies and the cultural backlash if they fail to do the job they are intended to do.

“In the second part of the period, Democrats were in control. They augmented the national security bureaucracy but spent the bulk of their energies expanding bureaucracies in domestic spheres."

"First, they passed a health care law. This law created 183 new agencies, commissions, panels and other bodies, according to an analysis by Robert E. Moffit of the Heritage Foundation. These include things like the Quality Assurance and Performance Improvement Program, an Interagency Pain Research Coordinating Committee and a Cures Acceleration Network Review Board."

"The purpose of the new apparatus was simple: to give government experts the power to analyze and rationalize the nation’s health care system. A team of experts on the newly created Independent Medicare Advisory Council was ordered to review and streamline Medicare. A team of experts within the Office of Personnel Management was directed to help set standards for insurance companies in the health care exchanges. Teams of experts serving on comparative effectiveness boards were told to survey data and determine which medical treatments work best and most efficiently."

"It’s a progressive era, based on the faith in government experts and their ability to use social science analysis to manage complex systems."

"This progressive era is being promulgated without much popular support. It’s being led by a large class of educated professionals, who have been trained to do technocratic analysis, who believe that more analysis and rule-writing is the solution to social breakdowns, and who have constructed ever-expanding networks of offices, schools and contracts."

"Already this effort is generating a fierce, almost culture-war-style backlash. It is generating a backlash among people who do not have faith in Washington, who do not have faith that trained experts have superior abilities to organize society, who do not believe national rules can successfully contend with the intricacies of local contexts and cultures."

"This progressive era amounts to a high-stakes test. If the country remains safe and the health care and financial reforms work, then we will have witnessed a life-altering event. We’ll have received powerful evidence that central regulations can successfully organize fast-moving information-age societies."

"If the reforms fail — if they kick off devastating unintended consequences or saddle the country with a maze of sclerotic regulations — then the popular backlash will be ferocious. Large sectors of the population will feel as if they were subjected to a doomed experiment they did not consent to. They will feel as if their country has been hijacked by a self-serving professional class mostly interested in providing for themselves."

'If that backlash gains strength, well, what’s the 21st-century version of the guillotine? “

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