As a traveling nurse, I witness what actually happens on the ground inside hospitals. I also read HuffPost, watch 60 Minutes, and catch the Sunday morning talk shows. I can't help but notice the enormous disconnect between my view from the trenches and the macro perspective of health care pontificators.
Reconciling their authoritative dictums with day to day hospital activity gives me a bad case of cognitive dissonance. Sometimes I think the easy way out is just to accept their ivory tower views -- delivered with such conviction -- and deny the evidence of my own senses.
The Centers for Medicare and Medicaid Services, known familiarly as the Center for Medicare Services or CMS, is a case in point. Let's just call them Medicare. Together with its twin, The Joint Commission, Medicare is the dominant consumer of health care.
They have the leverage of reimbursing gazillions in invoices submitted by doctors and hospitals. Their word is law. Even big insurers are no more than character actors in this drama, reduced to moving money from their healthy customers to their sick ones in strict adherence to the standards established by Medicare and The Joint Commission.
During the great debates of 2009, when epic shifts in American health care were being planned, the insurance companies took a hit for excessive paper pushing. The Princeton Professors and think tank theorists patted themselves on the back for identifying the administrative waste of the insurance companies. But these experts didn't notice how stealthily, over the years, the Medicare has exported its own massive overhead to service providers, leaving hospitals with more desk workers than caregivers. Bedside staff is co-opted to fill out mindless mandates, often at the expense of patient care. Having pulled off this shell game, Medicare now poses as a model of efficiency... and the analysts lap it up.
Yet, with all this apparatus and authority, Medicare is ineffective. They were perfectly positioned to lead the way to public understanding of the Affordable Care Act by educating their captive audience of nurses, physicians and therapists.
Democratic senators met with the White House Chief of Staff, Denis R. McDonough, on April 25 to complain that the new law was extraordinarily confusing to their constituents. Max Baucus (D-Mont.) was quoted as giving the administration "a failing grade" for explaining the new law to the public.
I hope these same senators aren't under the illusion that health care workers, to the contrary, know what's going on. That would be naiveté to the ninth power. We are as much in the dark as the general public.
Nurses and other hands-on caregivers receive an hour of formal education a month, usually in the form of an "in-service" classroom format, but also with on-line education. This continuing education normally deals with matters like preventing medical errors, establishing best practices and the latest schemes of the government to claw back monies from Medicare fraud.
How much imagination would it have taken to integrate the prospective changes in the way healthcare will be delivered and diseases prevented by ObamaCare into the already existing system of compulsory learning? Our patients expect us to help explain the new law. Nurses, doctors and others in the care chain might have made a substantial contribution towards educating the community at large. A dynamic Medicare CEO could have triggered this with a phone call.
Unfortunately, the top position at Medicare has been unoccupied for the last year and a half ... a critical moment in the rollout of ObamaCare. The last administrator (nominated by the White House and confirmed by the Senate) was Harvard educated Donald M Berwick, MD, who took office July7, 2010 and left December 2, 2011.
That vacuum of leadership has gone unnoted by both the media and political foghorns. This nonchalance speaks volumes about the actual depths of their concern for the healthcare of the average American. Certainly there would be a Beltway hue and cry if the Pentagon -- with a comparable budget -- went without a Secretary of Defense for 18 months. Resolving the mixed messages out of Washington is beyond my pay grade, but I'm comfortable calling out the mandarins of Medicare:
Guys, you are in a bureaucratic stupor, in need of a 12-step program.
Step one is to share your problems with the group.
"My name is Medicare, and I haven't had a leader since 2011. I can't remember my job description, but I think I'm supposed to be helping people."