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If Only the President Knew

May 31st, 2014 - 5:17 pm

John Hayward of Human Events watched president Obama’s little covered press conference after his acceptance of Veteran’s Affairs Secretary Eric Shinseki’s resignation. Hayward was looking for clues to the new talking points issued in response to the latest crisis.  He wrote:

Obama’s trying to pass the whole thing off as an unfortunate natural catastrophe, not deliberate malfeasance and shocking incompetence from himself and Secretary Shinseki, is both predictable and annoying… But it’s the President’s ensuing remarks that get really weird and outrageous. It’s not hard to see what he was trying to do: prepare the Sunday-show battleground with official talking points …

They’ve trying to unite behind the insulting and ridiculous position that the only real problem with the VA was insufficient funding – throw more tax money at the problem and everything will be fine! …

Another talking point Obama wanted to convey to his Sunday-show humanoids was a variation on the old “I just read about all this in the newspapers” dodge, in which he claims he and his top officials had no idea anything was wrong.

Something about the conference bothered him. While Hayward may simply have been paranoid, today’s opinion piece by CNN’s Gloria Borger provides an eerie confirmation of his suspicions. The piece, “Obama defeated by his own bureaucracy”, describes an idealistic president betrayed by his minions.  Mr. Smith came to Washington, but Washington proved too much for him.

(CNN) — When Barack Obama was a newbie president, there was no shortage of ambition or lack of confidence in the government he was about to lead. Government should be seen as a force for good, not evil. Sure, he told us, it needed to be “smarter and better,” but that could—and would—happen under his watch.

Never mind that Bill Clinton spent years “reinventing government” with mixed success. Or that only 2% of the American public believes that government can be trusted to do the right thing all the time. President Obama was convinced he could change all that with programs that would deliver for America—such as health care reform—and the public would be grateful.

Instead, the President is living his own version of “Alice Through the Looking Glass”: staring down a rabbit hole of government bureaucracy and inefficiency. The government he has studiously tried to grow, manage and change has become his own personal nemesis. All of which makes you wonder: Does the President himself trust government anymore?

Yet it’s not as if he couldn’t have seen the shoal water ahead.  If the Veteran’s Administration has turned out to be too complex to fix, then the much larger and more complex Obamacare program — which encompasses 1/6th of the US economy — may be in serious trouble.

Obamacare Flowchart

Obamacare Flowchart

Bolger’s assertion that ‘everybody knows government is hard’ is revisionist history. Ezra Klein confidently assured his Washington Post readers in 2009 that government delivered health care better. “Does The Government Run Health Care Better?” he asked. Yes he answered. He presented his view of healthcare systems in ascending order. “If you ordered America’s different health systems worst-functioning to best, it would look like this: individual insurance market, employer-based insurance market, Medicare, Veterans Health Administration.”  Klein’s claim was the VA was best, followed by Medicare.

Using government to deliver healthcare was the smart way, the European way, the wonk way to do it.

This assertion has since been called into question by events. The tragic problems of the VA are now too well known to bear repetition. But even Medicare doesn’t look much better.  Modern Health Care summarizes a recent report by the Medicare Inspector General revealing serious problems summarized in one word: “upcoding”,  a fancy name for bill inflation. Providers cheated Medicare out of $6.7 billion from coding errors alone in 2010. To solve things the CMS is going to “educate” the malefactors and exhort them not to do it again.

Medicare overpaid physicians $6.7 billion in 2010 for evaluation and management services, HHS’ Office of Inspector General said in a study released Thursday. The overpayments, which allegedly stemmed from incorrect coding and poor documentation, accounted for more than one-fifth of the $32.3 billion the CMS paid for E/M services that year. E/M services are basic patient health assessments performed at a physician’s office or clinic.

In a podcast, OIG officials Dwayne Grant and Rachel Bessette said they conducted the most recent study based on preliminary findings from 2012. In that report, the government found E/M services are “vulnerable to fraud and abuse” and that upcoding—billing Medicare for visits at higher, more expensive levels than they should’ve been—was rampant from 2001 to 2010. However, the agency was not able to discern if those E/M payments from its initial 2012 study were inappropriate. …

The newest report said 42% of office billings had incorrect codes, including those that were upcoded and downcoded, and 19% did not have sufficient documentation. The results came from a stratified random sample. The higher coders also were more likely to have errors or lack documentation, according to the report. …

The OIG recommended the CMS take three steps: better educate physicians on what is needed for E/M claims, follow up on erroneous claims and prompt private contractors to closely monitor E/M claims from high-coding physicians.

Medicare officials said they would ramp up education efforts, but they do not want to further audit doctors. The CMS said it has already completed one phase of medical reviews for high-coding physicians and started the second phase last August.

Whether this is likely to work I leave the reader to decide. It took 4 years to uncover the 2010 Medicare problems. At this rate of spotting fall of shot, we may find out how Obamacare is faring by 2018.  But we can guess already. Perhaps the most interesting Obamacare anecdote involves SERCO, a contractor running a data entry center in Missouri under a $1.2 billion contract.

Serco is supposed to process Obamacare applications, input the data into computers, and complete the sign up process, but the employee told KMOV that weeks could pass without an employee processing an application.

“The main thing is that the Data Entry side does not have hardly any work to do. They’re told to sit at their computers and hit the refresh button every ten minutes- no more than every ten minutes. They’re monitored to hopefully look for an application. Their goals are set to process two applications per month and some people are not even able to do that,” the employee said.

According to the Huffington Post, SERCO is still hiring. In that way they only need to hit the refresh button every 20 minutes. Ironically, the Washington Post more or less predicted this would happen because back in 2013, Sarah Kliff saw SERCO was an accident waiting to happen.

I wrote a story for today’s paper about Serco, the contracting firm that recently won a $1.2 billion health law contract. That story focused mostly on a British investigation of the firm’s parent company, Serco Group, for overbilling the government by “tens of millions of pounds.”

What didn’t make it into the story was some interesting background on the firm, which plans to hire 1,500 workers to handle any paper applications for health coverage under the Affordable Care Act. Most of it came from a conversation with Alan Hill, Serco’s head of media relations. Here’s what I learned.

Ninety percent of its business is with the federal government. Based just outside of Washington in Reston, Va., Serco is a 25-year-old firm that pretty much owes its existence to government contracting. “We have 8,000 workers across 45 states,” Hill said. “Since the beginning of our existence, we’ve worked heavily with the federal government.”

Serco’s experience isn’t in health care. It’s in paper pushing. The $1.2 billion health law contract was the company’s first under the Affordable Care Act, Hill said. But that doesn’t mean the firm is inexperienced. It has contracts with numerous government agencies to process applications. “This contract has a lot to do with records management, processing applications and that kind of work,” Hill said. “We do a lot of that work for other agencies, like processing visas. We do that work in New Hampshire and Kentucky.

Kliff saw it coming. But Obama didn’t. So is Kliff one of the betrayers or one of the betrayed? If president Obama really, really believed government could do it better and was simply double-crossed by venal and incompetent underlings then his education has been sadly deficient up to this point. But the phenomenon of the ignorant king has been described before.

The New York Times excerpted a passage from Anatoly Rybakov’s Children of Arbat in 1987. “The scene is the Arbat, the intelligentsia’s quarter in central Moscow that is now largely demolished. The year is 1934, the beginning of Stalin’s terror, when even relatives of the victims could still believe that the unexplained disappearance of their loved ones was some kind of mistake that would soon be set right, if only they could get word to Stalin.” In it Sofiya dreams of how Stalin would set things to rights once he learned of the injustice that had befallen them.

She would take out the newspapers and gaze at the pictures of Stalin, his simple clothes, the kind wrinkles round his eyes, the wise, calm face of a man with a clear conscience. He was 53. His oldest son was probably the same age as Sasha, and there was another son and a daughter. He knew what family grief was – he had only just lost his wife. If only Sasha’s case got to him. She was pinning all her hopes on Mark, her brother. He was the head of a huge construction project in the east, a favorite of Ordzhonikidze’s. The whole country knew who he was. Stalin knew him, received him and talked to him. Mark would tell Stalin about Sasha. Stalin would ask for the file, perhaps even call Sasha to him. And he’d like Sasha, he couldn’t help liking Sasha.

Yet she realized how futile these hopes were. Mark would not talk to Stalin about Sasha. But he had talked about Sasha to other highly placed and influential people. She trusted Mark. He had not tried to deceive her or calm her. He would do everything he could.

“If only Stalin knew”. That was the phrase that eluded Hayward when he was watching the Obama press conference. Here was the modern equivalent of the ignorant, idealistic king. If only Obama knew. Well he never does know, apparently, until he reads it in the papers. Maybe he should read Sarah Kliff.

Recent items of interest by Belmont readers based on Amazon click-throughs.

A Very Principled Boy: The Life of Duncan Lee, Red Spy and Cold Warrior
Sea of Shadows
Empire of Secrets Pb
Inside Gorbachev’s Kremlin
The Last Caliphate
The Wrong Enemy: America in Afghanistan, 2001-2014
Patient Safety in Emergency Medicine
Quantum: Einstein, Bohr and the Great Debate About the Nature of Reality

Did you know that you can purchase some of these books and pamphlets by Richard Fernandez and share them with you friends? They will receive a link in their email and it will automatically give them access to a Kindle reader on their smartphone, computer or even as a web-readable document.

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Rebranding Christianity for $3.99, or why the truth shall make you free
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Top Rated Comments   
Plausible denial isn't done for the sake of neutral observers – it's done for those who want to believe in the denial. It doesn't matter how plausible – or implausible – it is for you, because you aren't the audience. Obama supporters are the audience, and if a coherent fantasy is more believable to them than the unvarnished truth, they will continue to believe in a fantasy that conforms to what they want to believe.
39 weeks ago
39 weeks ago Link To Comment
If only Obambus had, like, read the job description before he applied, maybe he wouldn't have. But I still suspect he had no intention of *winning* in 2008, he just wanted to get his feet wet, get his name a little higher on the national recognition polls. Oops, he won.

Does Obambus know what a useless dick he is? I wonder if there's even an answer to that question. It's getting pretty obvious, but it hasn't yet penetrated to being a stated position by the MSM or Democrats, and as for Obambus himself, he really wouldn't want to live with that knowledge so I can assume he represses it, if it happens to occur to him.
39 weeks ago
39 weeks ago Link To Comment
Plausible Deniability works, until it becomes implausible.

Who has the copyright on the Obamacare flowchart? The GoP or some public spirited philanthropists, *cough* volunteers?, should produce millions of all sizes from billboard down to palm card size for a guerilla campaign. We need t-shirts.

Damn that Warren Harding. he and Hoover set this up as a trap but that great Democrat FDR saw through them. The Republicans should be ashamed of themselves for betraying the promise of that great Democrat who invented the VA, Abraham Lincoln.
39 weeks ago
39 weeks ago Link To Comment
All Comments   (29)
All Comments   (29)
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"Providers cheated Medicare out of $6.7 billion from coding errors alone in 2010."

Don't you have to also take account of Medicare's shocking and immoral underpayment for everything? Not that this kind of scam is the way to go, but I wouldn't be surprised if it all netted out in the end.
39 weeks ago
39 weeks ago Link To Comment
Why does anyone give a flying f*&k what Ezra Klein thinks about anything? I could throw a rock and hit someone more knowledgeable.
39 weeks ago
39 weeks ago Link To Comment
Does anyone?

Certain not anyone around here...
39 weeks ago
39 weeks ago Link To Comment
Agreed. He is remarkably clueless though quite confident about what he does not know. Jeff Bezos had the acumen to tell him to take a hike.

Get used to it. Today's journalists are lazy, ignorant, arrogant, opinionated, are quite certain of their righteousness, and their divine right to tell us Proles what to do.
39 weeks ago
39 weeks ago Link To Comment
Slightly OT.

From the Bilderberger Conference this weekend - in case you weren't invited , like me, is discussion point #6 :
"Critics of the US president blame him for betraying America’s leadership overseas, citing failures to defend American interests in Syria and lately in Ukraine. Obama’s newly announced doctrine calls on scaling down reliance on military force and using diplomacy and collective action instead. Bilderberg members will discuss whether this policy is doomed."

(From Zerohedge)

Boy, the bloom must be off the Rose. When the Socialist Old Guard, statis and crony protecting Bilderbergers begin to question whether Buraq's foreign "policy is doomed", Buraq is in deep Kimchi politically.
39 weeks ago
39 weeks ago Link To Comment
I don’t understand:

is government being taken by incompetents who can’t build a functioning system?

is government being taken by cronies who loot the system leaving an empty shell behind?

is government unable to build reliable computer systems and private business able to build reliable systems?

or are IT specialists defrauding the government by claiming the system can be built when they know it can’t be built.

If government is wasting its money on incompetents: fire ‘em, maybe the system can be fixed.

If government is being looted by cronies: jail ‘em, maybe the system can be fixed.

If government is incapable of building reliable systems, abolish the government.

If IT specialists are claiming impossible systems can be built, imprison them for fraud. Close down the government programs.

I vote for abolition.
39 weeks ago
39 weeks ago Link To Comment
Three and four are inextricably linked, EG.

They are not and cannot be unbundled. The IT industry oligarchs who are so deeply plugged in, blue-state model wise, to this administration, are party to the inability of the government (said inability predates tech, of course) being incapable of building reliable systems in this case.

The private business community figured out a long time ago that more than almost any other industry, IT (for all the good they have done, which is considerable) sold their services to the rest of the private sector as some miracle that would eliminate a great deal more of company expenses and would increase efficiency to levels which were never realized in the real world. Overblown marketing and expectations were the norm.

Cognizant of the old adage about "fool me once, shame on you, etc.", industry became gunshy of IT specialists promising the moon and stars over the past ten or twelve years. If it sounds too good to be true, and all that.

Unfortunately, although private industry became healthily skeptical of overblown promises of results by the IT industry, government and the academic/public sector ruling class, having no real world (private sector) experience with this paradigm shift, rushed headlong into exactly the same mistaken expectations that had hit the business world ten years earlier. Nobody in their circle actually stopped to look at recent history or ask people who had been through computerization and the whole dot-com bubble - and bust - about the possible dangers of relying on early adoption of unproven and oversold software in terms of results.

When you have a president who crafts a cabinet and staff that has the least percentage of individuals with private business experience in the nation's history, this sort of result cannot help but occur. They are incompetent, AND they will avail themselves of overpromising IT specialists who are fraudulent. Abolish, and imprison for fraud. Both.
39 weeks ago
39 weeks ago Link To Comment
IMO, all four are of a piece, and government was making these mistakes right alongside the private sector from the beginning. It is not so much a failure to learn from the mistakes as it is that the process of making these mistakes eventually became an arrangement that works for the entities involved no matter how badly it fails those of us paying the bills.

Through an unlikely series of circumstances, I did IT consulting around HR for almost fifteen years starting in 1996. During that time, I worked with pure private sector, government-contracting private sector, and government at the federal, state, local, and education levels. Sometime in that period, somebody had a white paper out there showing that public sector HR's spending is roughly four times as large as private sector HR's per employee, and that put public sector in the HR software market's driver's seat.

RFQs and RFPs even today contain wishlists of the form, "the system shall. . . " with at least one wish (and usually about a dozen) the IT equivalent of George Bailey's lasso-the-moon fantasy. Competitions like this can be won only by those willing to lie about their capabilities knowing they can argue about what the definition of, "is," is, should it become an issue later.

This is an excellent example of a statistician's endogeneity. Make a willingness to B.S. an entry requirement and then cry over being surrounded by B.S. artists.

P.S. I've worked with places staffed by Serco people. At the one I am most familiar with, the engagement was successful because Serco was only a thin management layer between the customer agency and high-performing retirees. But that layer was so thin that the arrangement was effectively a personal services contract.
39 weeks ago
39 weeks ago Link To Comment
"Using government to deliver healthcare was the smart way, the European way, the wonk way to do it.”

One thing we learn from history is no matter how many gulags, labor camps, work camps, death camps and "Organizations for Vigilance and Repression” Europeans create, the European way is the best way.
39 weeks ago
39 weeks ago Link To Comment
When Solzhenitsyn wrote about the apparat in the Soviet Union, most read it in horror. The Left saw aspiration.

It is working as designed.
39 weeks ago
39 weeks ago Link To Comment
I'm pretty certain Richard will touch on the Bergdahl situation soon enough, but I wanted to call your attention to something interesting about it.
If I'm reading this right, this guy is claiming to have been stationed w/ Bergdahl in Afghanistan and he tells quite the story about the circumstances around the disappearance of Sgt Bergdahl. I have zero idea if this is legit, but it's worth making some notes in case this stuff disappears soon. Unsurprisingly, this doesn't make the government's action today look so hot, if true.
39 weeks ago
39 weeks ago Link To Comment
You can't lead from behind unless their is someone in front of you. The trick is for us to put really well qualified people out front.

I just got the good news that one of the kids in my sailing class is about to graduate in the top 2% of her Chicago high school class and has been given a full ride in college for biomedical engineering / pre-med. That is the second kid in two years!

Note that unlike Boko Haram, we believe in GRRRRRRL POWER.

Ignore the pessimists and incompetents in the Obama Administration and go kick A**! YOU GO GIRL!
39 weeks ago
39 weeks ago Link To Comment
What about the meme-"I'm a better VA Secretary than my VA Secretary?"
39 weeks ago
39 weeks ago Link To Comment
“If only Stalin knew”. That was the phrase that eluded Hayward when he was watching the Obama press conference.

The irony of Rybakov's story is that Stalin did know. As eminent Sovietologist Robert Conquest has demonstrated convincingly in The Great Terror: A Reassessment, Stalin knew perfectly well that people were being rounded up, tortured into confessing to largely non-existent plots, then being shot or sent on a (usually) one way trip to the Gulag. How do we know? Because historians like Conquest were able to look in the Soviet archives and even Stalin's private safe after Gorbachev came to power. They found document after document with hundreds of names in each with indications that these people were to be executed along with Stalin's signature granting his permission to do so. Any thought that "if only Stalin" knew, these horrors would not have happened are pure fantasy: Stalin INITIATED these atrocities. His own paranoia was so extreme that he once admitted to Beria, the last of the chiefs of his secret police, that he (Stalin) feared that he (Stalin) was plotting against himself! With an attitude like that, it was inevitable that these atrocities would occur, ordered from the top by the very Stalin that the naive thought would have fixed the situation, if only he'd known about it.

Therefore, I hope you can forgive my skepticism at the notion that Obama would surely have prevented the mistreatment of veterans at the VA (or any of the other notable negatives of his presidency) if only he'd known. I can't prove for a fact that he initiated all of them but let's just say I have my suspicions....

39 weeks ago
39 weeks ago Link To Comment
No safe for Dear Leader, but perhaps a hard drive?

Richard, you are a M A N O N A M I S S I O N!!! I do so love the pieces you've been writing on DL!
39 weeks ago
39 weeks ago Link To Comment
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