The Power of “Why”

The number of health care bills being presented for our benevolence is overwhelming.  A bunch of radical liberal lawyers elected to represent us are hiring major lobby groups to write legislation. The writers must get paid by the page because the bills get longer and longer. I can only imagine that the cost to us will escalate with each page.

Intelligent Design

It is obvious to me that there isn’t a single problem solver in the entire administration. They haven’t got a clue as to how to approach the solution to health care reform. I was faced with cost cutting situations many times on my job. We never approached the problem by inventing a new one. The first step is to define the problem. The next step is to analyze where your money is going. The next step is to find the root cause. Then, and only then, could we design improvements or alternatives.

None of this is easy. It takes a lot of diligent effort and focus to stay on track. So far, I have heard only two things that define the health care problem: 1. The cost is too high. 2. End of life costs account for too much of the budget.

I also hear many remarks telling me that the bills will cut waste and fraud to pay for the improvements. Have you ever heard of a single page in any of the bills that is dedicated to finding and cutting waste? If you find one, let me know the number of the bill and the page, I want to read it. 

Put me in charge of this problem and I will come up with true reform, not reinvention to dump the old and begin with a new mire of costs. First, I would form a team of the best Black Belt Engineers that I know. We would insist on accurate definition of the problem. Second, we would conduct a Pareto analysis of the money being spent on the entire healthcare system. This would include the costs spent by insurance companies as well as providers. Don’t get me wrong, this is not simple. Getting those numbers would be a monumental charge. They are necessary however, in order to effect true reform. Currently, all we have is the total cost. In order to know how to reform, we need a breakdown of cost by functions. What are the functions: Administration, hospital, medical staff, supplies, records, legal, insurance, drugs, etc. Not having the cost categories in front of me limits how many categories I can assign charges to. All of these costs would then be totaled and charted;  the highest cost to the lowest cost.  My guess is that there would be one category that would tower over all the others.  Once I had that chart in front of me, the work of analyzing “why” begins. The greatest opportunity lies in the single largest cost function. Another method  we use to analyze costs is the 80/20 rule; eighty percent of the good comes from twenty percent of the activity. My black belt team would then begin asking “why” we incur the costs.  

The power of “why” resides in repeated questioning. Ask why. Get an answer;  ask why that is the answer.  Get another answer, ask why again, etc. eventually, the answers are harder to get. Eventually, the root cause of a problem becomes more evident.  Once the root cause is defined a solution is easier to effect. Sometimes the root cause is never found, and then change is chancy. It is my opinion that most of the time, the root cause would be some government intervention in the form of a law written by some representative to cover some obscure problem one of his constituents had. Politicians are famous for introducing legislation that insures a problem will never occur again. Years later, we learn the consequences of the law as applied to the general population.

Recently, I had a personal experience with an end of life situation. In an earlier post, I wrote about my beloved Aunt Marie passing. The bill she incurred while dying was horrific. I can see how the administration is touting end of life as a high cost element of reform. Here is what I saw. Marie is ninety-four. She has a multitude of physical problems that have made her last few months really miserable. She covered herself with a living will, and specific end of life instructions.  While helping her go to bed one evening, the attendant at her nursing home notice she was bleeding from her colostomy.  A hundred years ago, she would have simply bled to death at home. In a nursing home, the staff cries uncle and calls 911; why?  They are not equiped to handle a situation such as Marie’s. Why? She had prepared them with current instructions on the kind of treatment she wanted to keep her alive, yet they couldn’t grant her that request. They had to pass the ball to an emergency room. 

The ER finds her bleeding and begins treatment  by giving her blood. The hospital asks the family if  she has a living will? The document printed on bright orange paper stands out in the chart sent along with her records from the nursing home. Does anyone read these things, do they care?  By this time, she was admitted and being given blood to extend her life. $$$$$.

I consults with my daughter and  several doctors.  We learn that any further procedure to learn the cause of her bleeding presents an extraordinary means, and a violation of her body for very little else but more pain and suffering.   Since I am her DPOA (durable power of attorney), I request she go into hospice. She was sent back to her home to die. She expired within five days. It is my belief that giving her blood only extended her life for a week. The cost was covered by Medicare and supplemental insurance. It is high, but not as high as it would have been had common sense not prevailed.

True health care reform is improving the system in place, not re-inventing the round wheel to  make it square. My approach to reform is a logical one. The approach , however, does not yield control of our lives  to the government. It rather, keeps our liberty and makes us responsible to fix the problem ourselves. We can do it.

I have my team already picked. I know with the people I have in mind, we could make true reform happen within three years. It would be a logical, lasting reform of the health care system which would be the model for the rest of the world. We would use good old Yankee ingenuity and diligence to solve the problem, not legislation. Why not give me the chance to “get-r-done?”

A Light Went On

Dr Consults with Federal Obamacare for Direction In my world of engineering, I studied project management. Last week, I thought about one of the basic tenets of the training. A light went on above my head. A picture emerged on the subject of  health care. There is a rush by the democratic snake oil salesman to sell the American public on the need for a radical reform of the health care system. Never mind that the current system works fine for 75% of the people.

 I keep hearing about the 47 million people  who do not have health care insurance.  Of course twelve million of these are illegal aliens who shouldn’t qualify for any freebies from the government.  Another twelve million are people who wouldn’t buy or use health care insurance if their life depended on it. That reduces the forty seven million to twenty three million. In my book of arithmetic that translates into six and a half percent of the population that we are worried about. Using the laws of statistics, there is probably some error in these numbers. It might even be as high as six percent. If I have erred and the margin of error is on the minus side, the number of people who are uninsured is .5%. For that we want to create a government bureocracy that will bankrupt the country and take away our freedom.

What does all this have  to do with project management? The rule I learned was this; Good, Fast, Cheap–Pick Two.

The rule applies to making things or to designing health care systems.

1. If you want a good plan designed and implemented fast. It won’t be cheap.

Therin lies the national bankruptcy charge and the higher cost to the U.S. taxpayer, me and you. 

If you want a good plan that is cheap, It won’t be fast. 

 That is why we must slow this bill down. I know the guys in Washington  designing this reform are like  a room full of chimpanzees who are banging away on typewriters. Eventually the chimps will prepare the perfect plan.  Another way to look at this is you will stand in line for a long time to get service that is free. 

3. If you want a cheap plan that is fast, it won’t be good.

This is what Obama is directing lawmakers to give us.  Think about how many generations of Americans will be stuck with lousy health care service because the president wants it to be done fast, for what? I believe he wants it fast so we don’t have time to think about it. Kind of like passing a thousand page stimulus bill without knowing what is in it. I think health care warrants some careful planning and debate that will yield a system that is the best the country can devise, not one that is cobbled together by a bunch of self interest groups that have had pressure applied.

The thought of seeing my parents being advised by a government flunkie about  other options available than health care gives me the willies. I think if it comes to an mandated advisor coming to talk to me about options, I will give him a new one. i.e. the  option I have to excercise my second amendment right to defend myself from crazies.

It is sooo clear to me that the project management rule applies right on the money to our current situation.

President Obama wants a good plan, he wants it to be cheap, and he wants it fast. He can’t have it. He can only have two of the three.

We need to defeat the Health Care Reform Bill or break the rule of Good, Fast, Cheap.

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