Magnitude and Mortality in Healthcare
As individuals and by our nature, we humans are greedy -- some more, some less. And the greediest of all is the bureaucracy, particularly in health care. It is a cancer, one that is consuming the U.S. healthcare system and taking We The Patients -- that's you and me -- with it.
What is bureaucratic greed? Specifically, how and why is it at all different from individual greed?
First, we must recognize that the bureaucracy controls the government, not the other way around. Even as the bureaucratic parasite hides itself from us, it presents a public face: that of politicians and their appointed henchmen, bureaucrats. They work first for the bureaucracy, then for themselves, and we come last, if at all.
Washington does what is best for its bureaucratic master. In so doing, the members of Congress also feather their own nests. Consider the major pieces of legislation in healthcare over the past fifty years. Ask yourself: who is the real, consistent winner?
The list includes Medicaid, Medicare, HIPAA, EMTALA, UMRA, and recently the ACA. Are We The Patients better/healthier/more functional as a result of these acts? Is our healthcare system? Quite obviously, the answer to both questions is no. Are some politicians better, as in re-elected and more powerful? The answer is yes. Are some corporate fat-cat types richer? Certainly. But who is the big winner? The answer is this: while some won and some lost as a result of all that legislation, the bureaucracy gained enormously every time. It never lost.
The first difference between individual greed and bureaucratic greed is magnitude. The bureaucracy always "wins" much bigger than individuals. Whether it is laboratories that steal Medicare dollars, doctors who embezzle, or insurance company profits, their gains are in the millions of dollars. The ACA will take $716 billion from Medicare services to pay for ACA bureaucratic expansion. In one year alone (2011), the bureaucracy stole -- or, if you prefer, diverted -- $1 trillion from health care services and its providers to pay itself...to fund bureaucracy and bureaucrats. And the ACA itself is estimated to cost between $1.3 and $2.7 trillion over ten years.
Summarizing the how much question, the greedy bureaucracy takes a million times more dollars out of healthcare than the greedy individuals. Corporate fat cats and embezzling doctors are small potatoes compared to politicians and bureaucrats.
The why of bureaucratic greed starts with control. Both greedy people and the greedy bureaucracy need to direct money flow in order to satisfy the cancer of greed. However, they need that control for very different reasons.
Human beings are short-lived. Our greed must be satisfied in the here and now, with expensive houses and fancy cars. Our mortality drives us to have the trappings and freedom of wealth because we know we will die.
Bureaucracy doesn't need such transient human pleasures. It doesn't need the Beverly Hills mansion and the Rolls-Royce. It is immortal. Its greed can be satisfied only by growth.
Where mortal beings (animals and humans) are compelled to survive long enough to continue their species, bureaucracy has no "need" to survive because it never dies. Its compelling need is to expand, to grow. In order to satisfy that need, bureaucracy needs control of money flow.
Mortality is the second key difference between personal greed and bureaucratic. Individual greed is always limited by the person's mortality: a man's greed ceases to exist when he ceases to exist. Bureaucratic greed knows no such limit because it never dies. And because bureaucratic greed knows no limit, it constantly consumes more and more resources to support its "habit" -- its need for continuous expansion. If we do not control it, bureaucracy will feed on us until we both die.
Our country wastes hundreds of billions a year on EMTALA with its unfunded mandate, and the regulatory bureaucracy grows. HIPAA solves nothing for portability of insurance, yet the bureaucracy is rewarded with more money to expand. The ACA spends well over a trillion dollars while it cuts services, and yet it can "afford" to create six whole new federal agencies and hire tens of thousands (maybe hundreds of thousands) of new bureaucrats, whose salaries you and I pay.
If the picture seems bleak, it is only because we allow things to continue as they are. We have the power to rein in the bureaucratic parasite. We only need to exercise that power. Three straightforward changes in how we pass laws will do it.
1. No laws can be enacted without proof of effect, in advance.
2. No laws shall pass without first showing evidence from long-term cost/benefit analysis.
3. Every law passed will apply with equal force to members of Congress -- no exceptions. For example, Congress and its staff would be legally required to participate in the ACA. They passed it for the good of all Americans, and they are Americans.
Deane Waldman, M.D., MBA is the author of Uproot US Healthcare as well as The Cancer In Healthcare (September 2013). He is a member of the board of directors of the New Mexico Health Insurance Exchange, adjunct scholar for the Rio Grande Foundation (policy think-tank) in New Mexico, and emeritus professor of Pediatrics, Pathology and Decision Science at University of New Mexico. The opinions expressed here are his views alone and do not necessarily reflect the positions of those organizations.