Archive for September, 2012

Kill This Powergrab Project

September 27, 2012

   This past Sunday, (9/24/12) Robert Pear reported this in the NYTimes: the Obama administration is planning a pilot project to distribute questionnaires in hospitals and doctors’ offices for patients to report “medical mistakes”.  These would then be sent to research centers for analysis and, when sufficiently transformed into pure data, forwarded to the White House for…what, exactly?

   Your guess is as good as mine.  But I’ll give you mine first.  I see this as a maneuver that will try to preempt the expected counterattack from conservatives whose goal — or “crusade” if you will —  is to repeal the Affordable Care Act.  While this may serve a political purpose, its value as a measure of health care effectiveness is zero.

   Consider how this data will be used.  The article said the questionnaire is voluntary, and the information will be kept confidential.  One can only assume, then, that any public report will be pure statistical analysis.  Numbers, graphs and the like.  It will postulate trends and venture, with caution, that certain kinds of mistakes occur most often with patients of this or that demographic group, and…well, you get the idea.  The report will conclude — and of this you can be certain — that the project was a success because it “points the way” (such a useful phrase) for more extensive research into this growing problem .

   Growing?  Really?  Amazingly, this tiny seedling project will get attention, which is its real purpose anyway.  I’m sure only the nerdiest congressional staffers will be able to get through the report, but it will inevitably contain enough anecdotal goodies  of  gory medical ineptitude that the public, as fed by the media, will demand “a full investigation”.  Yes, somehow the “pilot”  will prompt Congress to bankroll the full miniseries, with “guest star” celebrity research wonks as an added attraction.

   Am I being paranoid?  Isn’t this only a responsible use of resources in order to better direct medical care?

   No, because the project, in its proposed form, could never do that.  It tries to translate the real experiences of health consumers into a composite made up of numbers only.  It will filter out the individual perceptions of the consumers, which are so varied, and so dependent upon unrecorded details, that no purely statistical breakdown can be accurate.  But accuracy is unimportant in politics.  The magic of numbers is useful in itself, especially when unpopular programs need to be fortified.

   But even if it’s useless, is it really harmful?  Yes, because the more citizens rely upon opaque statistical pictures of their own lives, the less power they have to hold their leaders accountable.  After all, numbers don’t lie, do they?  The well-worn trick is to find some common label to stick on any number of diverse stories, make a count of them, and then you can say they all say exactly the same thing.

   So now what?  I say do something now, before the project is approved.  I propose that we demand that every one of the questionnaires be reviewed by a government professional — not a private nonprofit like the RAND Corporation or ECRI Institute, which are going to analyze the data — so that any reported “mistake” that suggests a serious violation of medical practice, including possible criminal charges, be referred to the appropriate regulatory agency or the DOJ for further investigation.

   This is the only proper thing to do with this data.  Would we shrug off anonymous lists of bartenders serving underage patrons “by mistake”?  That would be OK for tabloid or cable TV exposes, but not for the government.  Once admitted into the public record, even the most cursory allegation of injurious conduct must be investigated.  How can we accept anything less?

   I won’t deny that my proposal may be considered disingenuous.  Better yet, I’ll admit it.  If these conditions were attached to the project, it would almost certainly kill it.  The small agency overseeing it, the AHRQ, has a limited budget and staff.   Now the administration would only have the agency transcribe and file the questionnaires, which would likely avoid congressional oversight.  But if it had to read and classify every charge of misconduct, and make appropriate referrals for the worst, it could not handle the workload.  The administration would also have to create guidelines for classifying the charges.  These would certainly require subcommittee review, and risk the entire project’s becoming a very visible test of the ACA’s survival.

   But what if the administration accepts the idea?  That’s fine with me.  I have no problem with serious scrutiny of professional conduct, especially when our health is involved.  I just don’t like empty political gestures that exploit the public’s anxiety, that’s all.  But as I said, I think the White House would back away from any practical use for this program.  They want to flash numbers and labels, and real substance removes all the value from that.  They would just as soon let it die.

   And good riddance.

The Next Moonshot

September 5, 2012

    I’m a regular reader of Tom Friedman’s column, and I wasn’t surprised by his latest enthusiasm: inspiring the nation to commit to a goal of “keeping everyone in school”(NYTimes, 9/2/12).  He’s a very credible “can-do” kind of guy, and his belief that America has the ability to thrive in a global economy is convincing because it is so reality-based.  He gives hardscrabble facts, and analyzes them.  He reminds us that President Kennedy promised a landing on the moon within that decade (the 1960s), and he delivered, albeit posthumously.  He says that with leadership that can inspire that kind of commitment, we can do the same with education.

    With all due respect, I doubt it.  Putting aside whether we, as a nation, feel the need to achieve that goal, there are too many unique variables in creating successful schools for us to be able to agree on any single master plan.  With a deadline, no less.  Can you see the Department of Education with the NASA playbook?  I can’t.

    In the first place, “keeping everyone in school” implies that there is a core of knowledge that all, or even most, Americans can endorse as essential for the national purpose.  We know that “readin’ and ‘rithmatic” alone won’t do that job any more, but what is the real curriculum for success today?  Let’s face it.  The very definition of work, by which I mean the labor one performs for compensation,  is in a state of flux.  How many new jobs today are full-time, and how many cannot be held to any predictable schedule?  How many jobs are for permanent employees, and how many for independent contractors?  It may turn out that having just one marketable skill won’t be enough for many workers, who may be forced to learn a second trade just to earn what a single job paid in the past.  In short, the workforce of the future may need to go back to school, and even then will probably earn less than their parents did.  If you think it’s hard to keep the kids in school now, just wait until that reality kicks in!

    Friedman’s analogy is inapt in another way too.  The challenge to reaching the moon was largely technological and financial.  Success depended on funding the enormous cost and using our best talent to solve the staggering number of problems inherent in the task, but we persevered, and prevailed.  Ah, but then we didn’t have the wilfulness factor to deal with.  The moon, you see, never failed to show up in its orbit to “hang out” with free-floating objects.  It didn’t ram into or otherwise attack the other revolving bodies, wasting an entire launch date.  No, the placid and dependable moon complied admirably.  It simply followed its eternal path and waited patiently to be landed upon.

    No, I don’t think educating America’s youth is analogous to the moon landing at all.  If it was, all we’d have to do is program our kids towards graduation, and launch them.

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