Monday, May 26, 2014

Health Care Shift to Private Sector

In advanced economies,  leaders are calling for key government enterprises to be denationalized or their tasks contracted out to be performed by others. Privitazation becomes a buzzword…An advanced ecnomy requires constant interaction between the two (government and business).

Alvin Toffler,  Powershift,  1990

On this Memorial Day, two events - one, the VA scandal,  death of veterans while waiting for care,  two, a  shift of care to private hospitals to shorten the wait – are taking place.

These events are part of a bigger problem – the inability of  government to rely strictly on its own people,  keeping everything in-house, without contracting tasks out to those with more competence .  

 “Power,” to use Toffler’s expression in his book,  Powershift, ‘has shifted away from the old hierarchs, creating a far more fluid, confusing system, with continually shifting centers of power.”

Nowhere is this power shift more evident than in the field of communication technologies.  When crashed and fell,  it was apparent in-house government IT experts were not up to the job of coordinating, enrolling and assuring  ObamaCare health plans would work.   Government experts did not have the skills, and there was no overarching  management  to control the process. 

Hence,  President Obama is being told  he must  relinquish control  of  and hand over and contract that control to an outside private CEO – someone with the experience to make it all work while satisfying the demands  of millions of Americans who depend on government for  health care coverage.   In other words, to paraphrase an old idiom, “may be good enough for government work,” but it is not good enough for the American people.

Similarly,   the VA system may be good enough for government bureaucrats,    and it may be good enough for those who espouse  a single-payer socialistic  government command and control system within the larger U.S. private system,  but it is not good enough for veterans and their families.

To be fair,  the VA is good enough to implement an integrated  electronic health record across its 1700 facilities,   it is good enough to satisfy veterans once they enter and are treated within the system,   its facilities  are good enough to serve as academic  training and educational  centers for half of  America’s physicians,   and its outpatient clinics are good enough to supply veterans with the prescriptions they need and tests and procedures they require.

But the VA is not good enough to meet the demands imposed by young veterans with post-traumatic stress disorders and amputations from Iraq and Afghanistan,    with  increasing numbers of women veterans, and  with aging  World War II, Korean,  and Vietnam veterans.  

Even with sharply increased budgets,  outstripping budgets of any other federal agency,  the VA is not up to the task.   The VA now spends 10% of its budget on outside private care.   This number will increase, no one knows how much, but it may take some of the political pressures it faces. 

Because of the government and the VA’s failure to live up to its promises of  faster, better,  and more timely care, power is beginning to shift back to the private sector, to privatization,  to interaction with private physicians and hospitals, who have  more incentives to please consumers.  

It comes down to privatization,  which may be defined  as  the process of transferring functions  of a  business, enterprise, agency, public service, or public property from the public sector (a government) to the private sector either to a business that operates for a profit or to a nonprofit organization.

Tweet : Failures and foibles of the VA and are causing  interaction and power to shift back to the private sector.

No comments: