Walter Reed Problems

[Wrote the first two paragraphs on 2/23/07, the remainder today.] Walter Reed has been in the news since the Washington Post did a 2-part series on problems there [this gives Friday's piece, with links to earlier ones], then Lehrer Newshour included a couple pieces and then the whole world (defined inside the Beltway as the authorizing committees and appropriations subcommittees of Congress) landed on DOD and VA. If I understand, wounded soldiers are moved from the hospital when they are convalescents into a set of buildings elsewhere on the campus. They're in charge of NCO's who are also recovering. Many are in a sort of limbo--maybe needing physical therapy or other treatment but too well to be confined to a hospital. From a military standpoint, some may wind up fit for duty, while others may finally be determined to be unfit. In part the problem is accentuated because medicine is saving more wounded, so they're recuperating from more serious injuries.

The situation seems to be a classical bureaucratic problem--you have a bureaucracy, Walter Reed Hospital, that prides itself on great medical care of the wounded. You have another bureaucracy, the Army, that has rules for able-bodied soldiers. But now you have a growing number of people who don't fit comfortably into either category. So the bureaucrats in power don't take responsibility, the facilities suffer a bit from neglect, the NCO's are overwhelmed, and the soldier/patients don't get what they need.

There's further complications: many soldiers want to remain in the service, so want to minimize their injuries and maximize their chances for recover. The services want to retain soldiers (though I suspect there's some hidden prejudices against soldiers with "disabilities"). On the other hand, if a soldier can't, or doesn't want to, stay in, he or she wants to maximize the injury so as to increase the disability benefits (realizing that not all soldiers fit the economists' "maximizing utility" model).

And still more: some soldiers are Army, some are National Guard, some are Reserve (presumably some may be Navy or Marine and some Air Force). Each one has, I'm sure, a different pay system, a different set of rules and regulations, and separate personnel offices. So Building 18 becomes the focus of a perfect storm, the point where multiple bureaucracies meet, and miscommunicate. And, because the VA services veterans where they live in civilian life, a surge of casualties resulting from the deployment of a Guard unit from a state poses problems for the local staff.

The number of investigations going on reflects the underlying complexity--each bureaucracy and its overseers have to do their own thing.

It's no comfort to the soldiers to know that some of this, as it relates to the Guard, is a direct result of the wisdom of the Founding Fathers.

Computer Problems

Make blogging difficult.

Great Day for Cats

The sun is warm and bright, streaming in through the windows on the south, reaching farther inside the house than it will in the summer, stronger and more long-lasting than it was in winter. The cats bask in it, sleeping without a care in the world.

More on FSA Computers

The High Plains Journal has a take on FSA's problems with its Web-based applications at the same time USDA is proposing to close offices:

"At the same time that FSA's national web-based program struggles, several state FSA offices have proposed closing selected county offices throughout the High Plains. FSA contends that these office closures will help provide more efficient service to producers. On one hand, FSA wants to jump into the 21st century by offering on-line program sign ups that reduce the need for producers to drive to county offices so often. On the other hand, they want to close marginally performing offices. The fatal flaw in this plan is the fact that the on-line program isn't working efficiently.

It makes sense for USDA to come out with an aggressive plan to fix their nationwide technology problems first or at least at the same time as they propose to close selected county offices. These two issues are not mutually exclusive. FSA has a long history of providing excellent service to producers in the field. Poor timing of reform proposals should not be a reason to tarnish such a laudable record."

(It's interesting that the web page seems defective.) This isn't exactly Catch-22, but in the ideal world farmers face the choice: drive more miles to deal with a bureaucrat with a face, or go online and deal with a faceless one.

History Repeats Itself at FSA

I never thought to see this:

The Associated Press story said that Teresa Lasseter, who heads the agency, complained that computers were so slow it sometimes took 10 to 25 minutes for a screen to come up. In January, the computer system worked sporadically or not at all, she said.

“It’s gotten better, but not as fast as we’d like it to be,” Kiel said.

Back in 1985-87 when the agency was first given minicomputers in the county offices, they turned out to be vastly underpowered for the stuff we were trying to do. IBM and the agency struggled for what seemed an eternity to try to get ahead of the curve, expanding storage, upgrading processors, etc. In the light of the power of today's PC's, it all seems ridiculous now. I forget what the parameters were then, but I think the biggest system had like 1.5 gigs of storage and maybe a meg of RAM. (These were IBM System/36's, supporting a number of terminals and printers.)

What seems to have happened today with FSA is that they've migrated applications off the System/36 (actually AS-400's which I believe are running emulations of the System/36) onto the web and their web servers aren't up to the task. Now if you ask me whether it's really FSA or it's the Department's IT people responsible, damned if I know.

There's probably only a handful of old timers there who remember the hammering we took on the Hill over the computer problems. Live and learn.

"Actively Engaged in Farming"

I was in the FSA website, trying to find data on corn prices. (It used to be there, but they've revamped the site and their PDF documents and I can't find it so I had to revert to Google.) But while I was there I ran across this fact sheet on the Administration's proposal for capping payments to producers with over $200,000 in "adjusted gross income". (I've an alternate proposal.) (Background, Senator Chambliss in the Senate Ag hearings took Johanns over the coals on the proposal, talking about farmers who had to pay off their equipment. This fact sheet explains there are 25 categories of deductions from income to arrive at AGI. It doesn't say that Chambliss was wrong, but I infer it.)

According to the IRS, 38,000 filers had AGI over $200 K and received farm payments.

"These 38,000 tax filers received 4.9 percent of all farm program payments or approximately $400 million.

The 38,000 tax filers who had an AGI of $200,000 or more and received farm program payments in 2004 includes both Schedule F filers and Form 4835 filers. Schedule F is filed by farm proprietors. Of all Schedule F filers, only 1.2 percent, or 25,000, had an AGI of $200,000 or more and received farm program payments.

Form 4835 is used by tax filers who don't materially participate in running a farm to report farm rental income or expenses. Of all Form 4835 filers, only 2 percent, or 13,000, had an AGI of $200,000 or more and received farm program payments in 2004."

What's not noted is that IRS and FSA have different definitions of "farming". If I understand correctly, IRS doesn't consider Form 4835 filers to be "farmers". But FSA does, under the permissive definition of "actively engaged".

User Interface at Fault--Bureaucrat Screws Up

They don't cite the name of the designer, but the conclusion of the panel in FL is that faulty design of the ballot is the reason for a 13 percent difference in votes between the Senate race and the House race. It shows the importance of forms, whether on paper or on the web, as a means of communication between people.

Pet peeve--all of the (mostly liberal) concern about the lack of an audit trail and the possible hacking of touch screen voting systems. Audit trails are good, but the energy is misplaced. As best I can recall the mechanical lever action voting machines never had an audit trail and presumably could have been hacked (sticking something into the gears to interrupt the counting of votes for a candidate). But we never worried.

How Important Are Farmers?

John Phipps has an interesting post on the importance of farmers in the economy. Based on Commerce Dept figures many "agricultural" counties get 3 to 10 times more income from transfer payments such as Social Security and TANF than they do from farming.

Our Health Care System at Work

Further experience with our health care system. My provider is Kaiser, which has its own doctors and labs in the DC area. But when someone covered by the plan travels outside of the area and has emergency surgery, you get into the complications of our marvelous system.

First of all, Kaiser doesn't take the step of assigning an event code when you call in to talk to them about the emergency surgery. Apparently the call is recorded, but there's no automated link to the bill paying process.

Because fee for service is competitive and individual, Kaiser gets bills for the surgery from:

1. emergency room physician
2. lab
3. pathologist
4. anesthesia
5. surgeon
6. hospital.
   

Each bill is individually prepared by someone in the relevant office and coded and routed to the appropriate Kaiser facility, or not. So far we've had bills go to Kaiser California rather than Kaiser MD, bills miscoded (according to Kaiser), bills with the wrong tax ID number on them (according to Kaiser), bills that have been delayed in the mail. Each bill seems to be considered individually by Kaiser (they do have a database that the administrative service specialist can check) and I'm informed individually of the payment or nonpayment (through a very poorly designed form). Whoever is considering them in Kaiser does not have an overview of what actually transpired on the ground but is either trying to interpret the fragments or, probably more likely, is mechanically following some rules. It's now been over 4 months and everyone has not yet been paid.

Because there are multiple parties involved (biller, multiple Kaiser offices, me), each of us thinks the problem is with the other. Each automatically believes that we've done our bit, now it's time for X to finish the job. That's part of the "faceless" part of faceless bureaucrats.

It's no wonder that we spend so much on health care.

Starbucks

The NY Times cites a memo from Howard Schultz, the founder of Starbucks, in this times article
but you can see the whole thing on starbucksgossip.com. (Although I drink the coffee every day, I've never bought their shares.)

It's interesting, not only the use of a blog within a corporation, but also the problems within a bureaucracy. What is the mission of Starbucks--provide great coffee at cheap prices or provide a great experience? He doesn't say, but some of the savings from the decisions made by his bureaucrats, to switch to flavor locked packaging for example, probably also enable them to be more environmentally conscious. How does a bureaucracy make the tradeoffs? His point is that he and his bureaucracy made decisions with tradeoffs of which they were not aware.