"The Potemkin Moment"
(Playing off "The Minsky Moment.") I have a picture, perhaps wishful, of the political system as a painted canvas, like a stage set, and then some clumsy galoof puts a foot through the it, or a kid pokes a hole in it with a pencil, and then suddenly everybody realizes what they thought was real and permanent and everlasting isn't. For example:
ObamaWar demotivates the Democratic base. 2010, here we come? [The Week]. Interestingly, Ryan Coole shifts focus at the end to this conclusion:
But let’s face facts: expecting our jalopy institutions to successfully navigate the rapidly shifting tangle of alliances in Syria is ludicrous. America is a country where the Secret Service doesn’t notice the White House has been shot until four days after the fact, and is apparently unfamiliar with how door locks work.
It sounds like Cooper’s been reading Naked Capitalism, or Golem XIV, or the Archdruid, all of whom would concur on our “jalopy institutions” (“corruption” is far too narrow a frame). Will institutional rot and demented and sclerotic elites become an issue in 2014 or 2016? Seems unlikely, but then what Ryan Cooper wrote above would have seemed unlikely too, until quite recently. It was also unlikely that Emperor Cuomo would have been challenged, but you can see Teachout and Wu working these same issues in their interviews with Naked Capitalism (the PayPal button is to your right), and they came out of nowhere to take 30% of the vote. So you never know! And remember that the legacy parties are jalopies, too, despite their fearsome appearance and noisy operation.
So, the operation run by the political class is ripe for a "Potemkin Moment," right? Here's another:
Nonetheless, the hospital systems seems to have had trouble confronting the challenges of the change in environment due to Ebola. Also, according to a very recent story in the Dallas Morning News, there have been performance issues at Texas Health Resource hospitals, and specifically at Texas Health Presbyterian,
Texas Health Presbyterian Hospital — under fire for releasing a Liberian man who later turned out to have the Ebola virus — has lagged behind its peers on emergency room care and lost some federal funds the past three years because it had high discharge rates of patients who later had to return for treatment.
The hospital scored significantly worse than the state and national averages in five of six emergency care indicators, with emergency room wait times twice as long as the averages, according to data from the U.S. Centers for Medicare & Medicaid Services.
The hospital also was the most penalized in Dallas under a three-year program designed to reduce the number of patients readmitted for care, according to the data.
The delays in patient treatment in the emergency room, in particular, raise important questions about Presbyterian’s emergency care, said Dr. Ashish Jha, a professor at Harvard University’s School of Public Health and a practicing general internist.
In 1988, Alain Enthoven advocated in Theory and Practice of Managed Competition in Health Care Finance, a book published in the Netherlands, that to decrease health care costs it would be necessary to break up the “physicians’ guild” and replace leadership by clinicians with leadership by managers (see 2006 post here).
Thus from 1983 to 2000, the number of managers working in the US health care system grew 726%, while the number of physicians grew 39%, so the manager/physician ratio went from roughly one to six to one to one (see 2005 post here). As we noted here, the growth continued, so there are now 10 managers for every US physician.
We have frequently discussed how generic managers in charge of health care organizations may follow business-school dogma at the expense of patients’ and the public’s health. In particular, they may also prioritize short-term revenue ahead of all other concerns, and hence may favor high-technology and procedural care, often performed electively, ahead of the the less glamorous and remunerative parts of health care, e.g., ED care of poor, uninsured, febrile patients.
Unfortunately, much of the country’s efforts to ward off Ebola are likely to be lead by generic managers who may have little understanding of epidemiology, public health or virology, and little understanding of the state of health care at the sharp end. So unfortunately I expect continuing “glitches,” or worse. Hopefully, the country, although not every single one of its inhabitants, will survive them. Then we need to seriously reflect on the wisdom of handing control of health care over to generic managers, rather than health care professionals.
The nurses ask:
If an Ebola patient becomes sick while being transported, ‘How do you clean the elevator?’
Basic, basic stuff! Another system ripe for a Potemkin moment.
I have heard that one reason the Soviet Union collapsed is that people ... just walked away from it. That was the Mother of All Potemkin moments. Does anyone have more knowledge on this point?