Health-care bureaucrats are clearly dangerous to our health, as we are discovering. But all bureaucracies, both governmental and private, tend to foster a mind-set that is risk-averse and incapable of dealing with serious problems. On the contrary, they often create even more problems by means of unworkable, capricious regulations and mountainous, time-wasting paperwork.
Doctors treat computers, not patients.
Doctors are now required to use electronic medical records. There are advantages, but privacy and time with patients are not among them. The last time I saw my internist, he spent less time looking at me than looking at his computer. Instead of scribbling a note, he now must enter the whole visit while I am there. The experience was similar to going to dinner and watching my companion spend the time on a smart phone. I wouldn’t eat dinner with that person again. But I may not have a choice with the doctor – they all may be like that soon.
Even worse, doctors will now have to use a new, complex coding system for diagnoses if they hope to be paid by Medicare, Medicaid, or insurance. The old book had 17,000 separate diagnostic codes – the new one has 155,000. But if the doctor or his clerk enters the wrong number, he not only won’t get paid; he may be accused of insurance fraud.
A system with 155,000 codes is certain to cause prolonged delays and frequent errors. No matter – the bureaucrats want to collect data and administer vast health-care programs. They aren’t concerned about providing actual care to actual people in order to improve their actual health. Of course, the programs will be seriously flawed, because they will be based on false assumptions, which in turn will be based on all this faulty data. Bureaucrats can live in a fantasy world; the rest of us are stuck in the real world.
But the numbers will look impressive on paper, and the PowerPoint will be awesome.
Captain Hassan gets promoted.
In 2009 Major Nidal Hassan shot up Fort Hood, murdering 14 and wounding 29 others, while shouting “Allahu akbar!” The media described him as murdering 13. No, it was 14 – one of his victims was pregnant.
Major Hassan used to be Captain Hassan. He went through a psychiatry residency while in the Army. He was observed daily by his colleagues and superiors. They were treated to his anti-American rants, which he presented instead of the psychiatric case discussions he was assigned. He tried to convert patients to Islam, a gross breach of professional ethics. Meanwhile, Hassan was in e-mail contact with the late Imam Al-Awlaki, who advised him that it was his Islamic duty to kill “infidel” soldiers.
Hassan was given mediocre evaluations, and the staff reportedly discussed whether he was a security risk. But nothing was done. No one wanted to be accused of being “Islamophobic” or opposing “diversity,” so only positive comments were put on paper.
Captain Hassan was promoted to major and assigned to Fort Hood, with the duty of caring for those about to go into combat and those returning from combat. We see how faithfully he performed his duty, and how well he earned his promotion.
Afterward, Army Chief of Staff General Casey declared, “And as horrific as this tragedy was, if our diversity becomes a casualty, I think that’s worse.” Diversity of what? Race, religion, ethnic origin, or gender? Fine. But diversity of loyalty? Can we tolerate some troops who are loyal to the United States, and some who are loyal to our enemies? That leads to the ultimate diversity – some troops who are above ground, and some who are in it. There, is that diverse enough for you, sir? The bureaucracy failed to protect the lives of those it was responsible for. It did succeed in protecting itself from accusations of “intolerance,” and that’s what’s really important, isn’t it?
But Hassan looked good on paper.
Jerry Sandusky counsels more kids.
Sandusky was a long-time assistant football coach at Penn State, under legendary head coach Joe Paterno. In addition, Sandusky headed a charitable organization for troubled boys. Both activities served the ulterior motive of attracting boys.
One day Mike McQueary, a former football star and at the time a Penn State assistant, entered the shower room and found Sandusky apparently having anal sex with a 10-year-old boy. McQueary’s response was to slam his locker door to announce his presence, then leave. The next day he notified Paterno, who in turn notified university officials – who discussed the situation. Only years later, Sandusky was convicted on almost all counts and given what amounts to a life sentence.
But McQueary was a large, strong, young man. He could have beaten Sandusky to a pulp and warned him never to do it again. He could have taken the boy home and informed his parents. He could have called the police. But he was so enmeshed in the bureaucracy that he felt he had done his duty if he informed Paterno, his superior, just as Paterno felt he had done his duty when he informed his superiors. Call the cops? Protect the kids?
But that’s not my job description.
James Holmes triggers a report – and three guns.
James Holmes murdered 13 and injured 58 in the Aurora, Colorado movie theater. Media reports claim he murdered 12, but one of the injured women miscarried. Holmes was in a PhD program at the University of Colorado-Denver. But he was not doing well and was seeing a university psychiatrist.
His condition worried his psychiatrist enough that she reported him to the threat-assessment team. But by that time, Holmes was dropping out of the university. The threat-assessment team decided that Holmes was no longer their problem – and did nothing.
Instead of using three firearms and multiple tear-gas grenades to attack the showing of “The Dark Knight Rises,” he could have attacked a lecture hall filled with Psychology 1A students, and perhaps murdered even more. But the threat-assessment team didn’t assess that threat. Nor did they assess the threat that he might attack an off-campus target like a movie theater. Perhaps they were too busy assessing the threat that if they did anything, they might be sued, or (horror!) accused of being politically incorrect. So nobody notified the police.
Here we run into serious problems with doctor-patient confidentiality. But physicians and psychologists are obligated to call the police if a patient is a danger to himself or others.
It seems likely that Holmes was descending into schizophrenia, which often becomes evident in the late teens or twenties. Only a small fraction of schizophrenics become violent, but those who do present a serious problem. If we are too proactive, we may involuntarily hospitalize people who could have done well as outpatients. But if we are too inactive, we may wind up at the midnight showing of “The Dark Knight Rises.” In any case, doing nothing is not acceptable. “It’s not my problem” is a really big problem.
But we filed a report.
In the end, the risk-averse paper-shuffler may pose the greatest risk of all. The bureaucratic mind sees papers as the ultimate reality. If you ask a bureaucrat what is happening – for example, regarding ObamaCare – he will remain seated at his desk and look down at a stack of reports. He will not get up, leave the office, and see what is really going on. Those who expect Big Government to solve our problems should consider this worrisome fact.
A paper-obsessed bureaucrat is as dangerous as a texting truck driver. Neither one notices the “little people” he runs over.

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