On Medicare, CEO’s, and Throwing Stones…

By  |  March 4, 2013 | 

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:

As presently organized:

“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.


UPDATEOn CMS’s lack of confirmed administrator (“CEO”):

“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.”

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  1. […] Posted at The Hospitalist Leader on 3/4/2013 Bradley Flansbaum, Co-host of The Hospitalist […]

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About the Author:

Brad Flansbaum
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education. Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates. Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University. He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.


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