The protests against health care reform range from fullscale insanity (death panels) to verging on reasonable (budget deficits), and the people who are against it range from well-intentioned citizens to disgusting bottomfeeders. One of the most common arguments against the so-called public option is that health care will be managed by government bureaucrats, which means inefficiency, which translates into having to wait. If there's one thing the typical American hates, it's having to wait in line for anything.
At any rate, I spent virtually my entire adult life working in some type of government bureaucracy, so I believe I'm qualified to discuss them from a moderately informed perspective.
In terms of sheer mindblowing inefficiency, the United States Army probably had more silly rules and regulations than any of the other organizations I worked for. The accomplishment of military missions depends on discipline up and down the chain of command, which is fostered by having written rules for everything and an unwavering expectation they'll be obeyed. Most people like the protection the military services provide, so their bureaucratic inefficiency is generally ignored unless it causes some disaster or a loss of life.
From 1972 to 1998, I worked in the state's public welfare system, the first 32 months as a caseworker and the remainder as a unit supervisor. The welfare bureaucracy as I knew it was probably comparable to a future government organization determining eligibility for medical services.
Throughout my career, I was assigned to various administrative units of between 12-18 state employees, either as an eligibility worker or supervisor. For discussion's sake, I'll say the average was 14, although it may be actually have been slightly more or less. I supervised a variety of urban and rural offices, some as small as two caseworkers and a clerk, some as large as 9-10 workers and several clerks. I usually had a personal secretary as well.
My first observation is that almost always, about 50 percent of my staff members (Group A) were outstanding employees with highly developed technical skills and admirable work habits. Then there were an additional 40 percent (Group B) who were competent, diligent and dependable, but were slightly more error-prone than the elite staff. Finally, as a general rule, about 10 percent of my subordinates (Group C) were what I'd call high maintenance. They'd have difficulty mastering the policy knowledge and technical skills the work required, or had problems with attitude or absenteeism. I guess most first-line managers would classify and distribute their staffs in similar proportions.
Benefit applicants whose cases were handled by Group A staff were consistently happy with the service they received, and those handled by Group B generally had minor complaints, if any. Client complaints usually came from people whose cases were handled by Group C staff, and invariably involved allegations of rude treatment or processing delays, often both. Often, when processing time began to drag out, applicants would start calling several times a day to bitch about it, and eventually their worker would get fed up and reply rudely. To put it another way, about 90 percent of the complaints were caused by 10 percent of the staff.
Since our work involved providing financial assistance to low-income people, Texas taxpayers generally had a low opinion of us and the people we were trying to serve. Ronald Reagan didn't help matters with his myths and fabrications about welfare queens in Cadillacs. The state legislature tolerated our agency as a necessary evil, but was usually looking for ways to discourage poor people from applying by regularly requiring them to jump through new sets of hoops. In the age of Gingrich and Clinton (at the federal level) and George W. Bush (at the state level), this was known as "welfare reform."
As an unpopular department providing unpopular services, our constant focus was on quality control, meaning fraud prevention and benefit accuracy to the penny. If a client received ten dollars per month more than she was entitled to, that was assumed to be concrete statistical evidence that actual benefit errors were in the hundreds of thousands of dollars, with federal matching funds to be withheld accordingly. Errors led to added demands for precision, leading to increased verification requirements, leading to delays in processing, leading to client complaints, resulting in more errors, all in a never-ending loop of futility. The fact that Congress and the legislature were routinely changing the rules of the game only made the situation worse.
Ours was a high-pressure, high-stress working environment --- unfortunately, the elite Group A employees sometimes burned out and sought advancement, either up the departmental food chain or in other lines of work. The qualities that made them Group A members also made it easy for them to move on --- much easier than it was for me to replace them with new employees possessing comparable abilities.
In retrospect, I'm amazed my staff members were able to accomplish as many good things as they did. After some legislative sessions, the department would be under a reduction-in-force directive, meaning we were expected to do more work of higher quality with fewer employees and new rules to learn.
Having survived in a bureaucratic environment for so many years, I understand what bureaucrats are up against and I bear them no ill will. With most of our income these days paid through government retirement systems, my wife and I still depend on bureaucracies, and I'm impressed with how effectively and smoothly they operate. Getting into the Social Security retirement system was surprisingly easy, somewhat to my amazement after reading so many chatroom comments about how tough it would be.
The bottom line for me: There may be reasons for me to worry about the public option, but fear of bureaucracy won't be among them.
