Saturday, April 14, 2007

Satire - Have Bureacrats read aloung all government regultions, Modest Proposal

For Preventing Misguided Americans from Becoming Confused, Driven to Alarm, or Led to Believe Government Programs Are the Final and Only Answer to Prolonging Lives, Curing Disease, Restoring Health, or Protecting Against Financial Insecurity, with Apologies to Jonathon Swift, Recorded This Date, The Fourth Month and The Fourteenth Day, in This Year of Our Lord, Two Thousand Ought Seven,

Annum Horribili

It is a melancholy object to those who are citizens of this great country, when they read in the newspapers, witness on national television, peruse blossoming blathering blogs, hear from pontificating politicians, and glean from ponderous policy pundits, about this nation’s horrific health woes – that is, its health system is broken beyond repair, leaving millions of uncared-for, unpaid-for poor, and unprovided-for destitute citizens in its cruel woeful withering wake.

I think it is agreed upon by all parties that the woes of the prodigious number of unwashed masses of uninsured, wallowing helplessly in destitution and shamefully neglected by their more affluent fellows, should be addressed in the most magnanimous and generous fashion as humanely as possible. This is particularly true of the plight of children in the arms, or on the backs, or at the heels of their mothers, and frequently of their fathers.

This is a deplorable state of affairs for this great nation, the most powerful and affluent super power on the face of the earth. Given our immense wealth, surely we can provide for all among us. There simply must be a fairer, cheaper, and easier method for addressing the horrendous horrors of the health system and for preserving this nation’s health and saving us from miserable, miserly, miseries at the end of our time on this Good Earth.

Having turned my thoughts for many years on this important subject, and maturely weighed the several schemes of many others, including those:

• Who would have our noble government care for all,
• Those less noble who would have those acting in their own financial self interest guided by some invisible hand as Adam Smith (1723-1790) suggested and accepting responsibility for their own health and wealth in the competitive merciless marketplace,
• Those who wail that health care must be rationed because of the looming prospects of the “Tragedy of the Commons,“ whereby free access and unrestricted demand for the finite resource of health care dooms it to overexploitation by greedy profiteering scavengers and unconscionable pirates seeking their own good rather than the common good.

I have come upon a two-part scheme to avoid and disrupt the travesty and tragedy of the dire and apocalyptic chain of events that may yet lead this great nation into an epidemic of ill-health or downward spiraling financial collapse with disappearance into the abyss of bankruptcy of this great and gallant nation.

And that is, to have the hundreds of thousands, nay, may I say millions, of employees, functionaries, medical professionals, lawyers, technocrats, and bureaucrats of the Health and Human Services, the Federal Drug Administration, the Centers of Medicare and Medicaid, and all other assorted health agencies, and indeed of the Congress itself as well at the Presidential Administration, who collectively enforce and administer the rules of the health care at the federal, state, and local levels, as embodied in 99,177 still rising numbers of pages of the policies, manuals, and rules of government relating to health care, which are part and parcel of the monitoring guides of the fifth largest budget on this planet, after the U.S., China, Germany, the United Kingdom, and Japan, with the state of California close behind, to execute and carry out two essential, indispensable, and long overdue functions necessary for the survival of the Republic and health care system.

I. Have each government employee read aloud all of those 99,177 pages, day and night, weekdays and weekends, round-the-clock, unceasingly, unstintingly, without respite, non-stop, on holidays and non-holidays, to themselves, families, and friends, in order to, and with the intent of, deciphering the codes and regulations therein, and with the ultimate goal of translating them into Plain English for the assembled masses of uncomprehending and hopelessly confused Americans.

I calculate reading aloud the 99,177 pages, at 500 words per page, at the rate of 160 words per minute, would take each employee 3,097,428 minutes, 51,524 hours, 2151 days, or 52.7 years to complete this reading if it were to be nonstop. This, of course, would be asking too much of each already overburdened federal employee.

To make this formidable task more acceptable, we could have each employee read for an 8 hour shift each day. But that would lengthen the time required to consummate this awesome but necessary task to 158.1 years. Most of us, including those of us who must translate and put these rules and regulations into action on health care grounds, in the clinical trenches, and in corridors of care in charitable and non-charitable institutions and academic medical centers, do not have that sort of time.

So, as a compromise, we could have rotating shifts of readers and listeners. Perhaps the greatest and most enlightened benefit of this munificent and magnificent part of the first section of this proposal is that it would leave no time for members of the federal establishment to write new rules and regulations, or to re-interpret, redefine, reconfigure, or otherwise re-confound old rules and regulations.

The proposition has been advanced and calculations have been made that fully one third of the gross national cost of health care in the Kingdom known as the United States resides in administering and unraveling the complexities, Byzantine, labyrinthic, and convoluted rules and regulations that descend from the Citadels of Power on the Potomac, which lies in the province of D.C., short for Darkness and Confusion. In one fell swoop, my proposal would subdue, perhaps even slay, this Cost-Generating Monster.

II. Make it a condition of employment and job training for health-related government employees, technocrats, and bureaucrats at all levels of this vast, complicated, and sprawling enterprise, that they spend one month (30 days), depending on their expertise or function, actively working in one of the following places: physician practices, hospital corridors, front or back offices of all health care providers (be they doctors, hospitals, hospices, home health agencies, skilled nursing facilities, rehabilitation institutions, visiting nurse associations, nursing home providers, supportive personnel, academic medical centers, homes of sick patients, their families, and relatives,) witnessing first hand how their bureaucratic garrulous gobbledegook delays care, diverts attention from the sick, drives up expenses, and sometimes induces hopelessness and helplessness among those they seek to serve and among those who seek to understand and care for the sick.

It is surely not asking too much to have the plenipotentiaries, potentates, and powerful among the federal and state health establishments to walk in the moccasins of their powerless, impotent, and plebian beneficiaries.

I can think of not one objection that will possibly be raised against this two-part proposal, unless that it will demoralize and maybe even demonize loyal, scrupulous, and meticulous health care governmental employees by making them realize the consequences of their rules and regulations on commoners and practitioners of the various and heterogeneous health care arts and sciences. This I freely own, and 'twas indeed one principal design in offering it to the world.

I desire the reader will observe, that I calculate my remedy for this one individual nation of the United States, and for no other that ever was, is, or, I think, ever can be upon Earth. Therefore let no man talk to me of other expedients:

• Of taxing our citizens at a higher rate;
• Of utterly rejecting the materials and instruments that promote luxury;
• Of curing the expensiveness of pride, vanity, idleness, and gaming in the well-off;
• Of introducing a vein of parsimony, prudence and temperance;
• Of learning to love our country, wherein we differ even from Europeans, and the inhabitants of Canada:
• Of quitting our animosities and factions;
• Of being a little cautious not to sell our country and consciences for nothing;
• Of teaching bureaucrats to have at least one degree of mercy towards their recipients and beneficiaries;
• Lastly, of putting a spirit of honesty, industry, and skill into our bureaucratic employees, who, if a resolution could now be taken to buy only their own goods, would immediately unite to cheat and exact upon us in the price, the measure, and the goodness, nor could ever yet be brought to make one fair proposal of just dealing, though often and earnestly invited to it.

Therefore I repeat, let no man talk to me of these and the like expedients, 'till he hath at least some glimpse of hope, that there will ever be some hearty and sincere attempt to put them into practice.

But, as to my self, having been wearied out for many years with offering vain, idle, visionary thoughts, and at length utterly despairing of success, I fortunately fell upon this two-part proposal, which, as it is wholly new, so it hath something solid and real, of no expense and little trouble, full in our own power, and whereby we can incur no danger in disobliging America.

After all, I am not so violently bent upon my own opinion as to reject any offer proposed by wise men, which shall be found equally innocent, cheap, easy, and effectual. But before something of that kind shall be advanced in contradiction to my scheme, and offering a better, I desire the readers will be pleased maturely to consider my two points.

I profess, in the sincerity of my heart, that I have not the least personal interest in endeavoring to promote this necessary work, having no other motive than the public good of my country, by advancing the cause of all humanity, providing for infants, relieving the poor, and giving some pleasure to readers and recipients of this worthy scheme.

The End


Dr. Val said...

Great post! Look at this latest bureaucratic nightmare created by JCAHO: (from rant at Movin' Meat blog):

Once again, the bureaucratic mindset took control of the residual brainstems of the great thinkers at the Joint Commission, and heedless of the lack of qualified pharmacists to review the volume of orders for meds in the ER, mindless of the needless delays in dispensing critical medications, mindless of the obligate delays in care, increased length of stay, increased waiting times, impact on patient flow, etc, they reinstate a stupid rule which not only unnecessary but potentially detrimental to patient care.

Richard L. Reece, MD said...


Thank you for compliment. But when talking about federal rules and regulations, I'm realistic. Government, in one form or another, now pays for 47% of health care, and when you're spending taxpayer money, you're going to have bureaucracy. Also other insurers follow Medicare rules. None of this is going to go away because Medicare is the Sheriff of the system.

My main hopes in writing this satire were: 1) to have fun; 2) to sensitize bureaucrats to the consequences of their "mindless" rules.

I welcome other comments.

Richard L. Reece, MD