Posted by
Andrews on Thursday, October 15, 2009 4:52:12 PM
As my regular readers know, my wife works as an RN at a local hospital. What is interesting is the number one complaint she has, and that she says she hears from other nurses and doctors. That complaint is, thanks to both HIPAA (a federal privacy law) and private hospital certification bodies, she is required to spend more time doing paper work and documenting things than actually taking care of patients.
Now, admittedly, some of this is private and not government mandated, but only on a superficial level. Then again, as certification is often required to qualify for reimbursement from both government and private insurance, the degree to which is is "voluntary" is debatable. (See
this page for a critical view of JCAHO, almost as negative as my wife's.) And, in addition to the private certification, the government does impose a huge burden of paperwork, both explicitly, through regulation, and implicitly, by lax liability laws which make hospitals obsessed with documentation to avoid nuisance lawsuits.
The reason I bring this up is because of the claim made by many nationalization advocates that government takeover will somehow "allow doctors and nurses to get back to taking care of patients." According to these misguided individuals, the relatively small amount of paperwork required by insurers, mostly done by non-medical personnel, is keeping doctors and nurses form doing their jobs. What makes this especially absurd is that the biggest impediment to care seems to be documentation requirements, which are mostly driven by government or liability fears. And which, most likely, will only increase under a government health care system.
So, please, do not believe that somehow the free market, or as free a market as we now have (which is far from free) is somehow preventing medical staff from caring for patients, and that imposing a massive bureaucracy onto medical care will somehow improve efficiency. If you want to see the outcome of government control, look at the example the president himself offered (until advisors told him how bad an idea it was), he will make medial care as efficient as the postal service.
Next time you are standing in line, waiting hours to be seen by a clerk who is either snarling or half asleep, who claims to be unable to find your lost package until you fill out a fifteen page form describing it, just imagine putting your life in the hands of that man, or in the hands of the letter carriers who deliver your neighbors' mail to you day after day. Or maybe in the hands of those who deliver letters a year late, or torn into tiny shreds, or both. That is the efficiency that Obama is promising to bring to medicine.
POSTSCRIPT
I do give the president credit for unusual honesty in his comparison of government medical care and the postal service. Of course, in reality, it is more a sign of how out of touch he is than anything else. To politicians the postal service is made up of the nice gents who send out your mailers free and render obsequious service since you control their funding, not the surly, confused, bureaucratic and oblivious chaps with whom we mere mortals, lacking congressional franking privileges, have to deal. Amazing how his brief stint in congress erased all of Obama's memories of being a mere mortal.
And before any postal workers complain, my uncle was a postal worker, so I know there are better and worse postal workers. However, thanks to the incentives of the system, there really is no encouragement to work hard in the postal service. As with union jobs and other government posts, the incentives all favor those who serve their time and manage not to make any waves, regardless of work quality. So, though some may retain a dedication to hard work, in general the system encourages apathy. And, in my experience, those incentives have a palpable effect on the quality of service.
POSTSCRIPT II
I made a similar point in "
Disgruntled Workers".