I have been deliberating on Medicare (again), since the release of Time Magazine’s Brill piece last week. The quote below gets at my thinking:
“Medicare violates every rule of an efficient enterprise. It has no CEO with powers of a kind expected in business.
Its stakeholders, the Congress, have a right to interfere with its day-to-day operation.
It has no annual budget or the fiscal discipline that imposes. It can set few limits to its expenditures, even to the present point of running an annual deficit.
And it underpays its administrators in comparison with those with like responsibilities in the private sector – just as it has too few administrators in the first place.”
Which gets to a bigger question. How do you reform and make more efficient a federal agency–so they function more like IBM or P&G? I searched and read. You can tinker at the edges, but government and public financing by definition make congressional oversight the rate limiting step in liberating performance restraints.
Legislators like to throw stones at CMS. They would be well served to read above, rinse, and repeat (with 2% less soap). They would be also become more enlightened and spic and span in doing so.
“Imagine a large company operating for seven years without a CEO. A company with a product that accounts for more than 15 percent of our nation’s gross domestic product. A company implementing the largest national effort at reform since its creation. A company set to gain an additional 30 million customers in the next year.
Yet that is exactly the situation at one of the largest federal “companies.” The Centers for Medicare and Medicaid Services (CMS) has not had a Senate-confirmed administrator since 2006.”