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Posts Tagged ‘Waste’

When government suppresses the free market and takes over the healthcare sector, you get some really odd results.

Consider these stories from Sweden:

 A man sewing up his own leg after getting frustrated with a long wait.

The government denying a wheelchair to a double amputee because the bureaucrats decided his impairment might not be permanent.

Speaking of amputations, an unfortunate man was put on such a long waiting list that his only treatment, when he was finally seen, was to have his penis removed.

Today, we’re going to augment that list. But not with another story from Sweden, which is actually a much better country in terms of public policy than most folks realize.

Instead, we’re going to look at some great moments in government-run healthcare in both the United States and the United Kingdom.

Our first story is from the Chicago Tribune and it deals with Medicaid and Medicare spending.

But we’re not going to look at the aggregate data. Those numbers are very sobering, to be sure, and you can click here and here to learn more about that problem.

Instead, we’re going to drill down into the details and get some up-close evidence of why the programs are so costly. Simply stated, providers learn how to bilk the government.

A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions. Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.  And then there was this: The sessions were often being performed by obstetricians and gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled. So Medicaid began cracking down, and spending plummeted after new rules were implemented.Illinois doctors are still billing the federal Medicare program for large numbers of the same services, a ProPublica analysis of federal data shows. Medicare paid Illinois providers for more than 290,000 group psychotherapy sessions in 2012 — more than twice as many sessions as were reimbursed to providers in New York, the state with the second-highest total. Among the highest billers for group psychotherapy in Illinois were three OB-GYNs and a thoracic surgeon. The four combined for 37,864 sessions that year, more than the total for all providers in the state of California. They were reimbursed more than $730,000 by Medicare in 2012 just for psychotherapy sessions, according to an analysis of a separate Medicare data set released in April.

Some of the specific examples are beyond belief. Keep in mind as you read the next passage that there are only 365 days in a year, and only about 261 workdays.

Of the Illinois OB-GYNs billing for group psychotherapy, Dr. Josephine Kamper had the highest number of sessions. She was paid for 10,399 sessions in 2012, at a cost to Medicare of $207,980. …Another OB-GYN, Lofton Kennedy Jr., billed for 9,154 group psychotherapy services. He declined to comment. The third-highest-billing OB-GYN, Philip Okwuje, charged Medicare for 8,584 group therapy sessions.  

Illinois isn’t the only place where taxpayers are getting ripped off.

A Queens, N.Y., primary care doctor, Mark Burke, was paid for more sessions than anyone else in the country — 20,841. He accounted for nearly one in every six sessions delivered in the entire state of New York in Medicare, separate data show. He did not return messages left at his office. Another large biller was Makeba Gordon, a social worker in Detroit. She was reimbursed for nearly 5,000 group therapy sessions for her 26 Medicare patients, an average of 190 each. She also billed for 2,820 individual psychotherapy visits for the same 26 patients, who allegedly would have received an average of 298 therapy sessions apiece in 2012. Gordon could not be reached for comment.

And I’m sure you won’t be surprised to learn that the bureaucracy in Washington doesn’t seem overly worried about this preposterous waste of money.

Aaron Albright, a spokesman for the U.S. Centers for Medicare & Medicaid Services, said in an email that Medicare has no policy regarding which physicians may perform group psychotherapy. During such sessions, “personal and group dynamics are discussed and explored in a therapeutic setting allowing emotional catharsis, instruction, insight, and support,” according to rules set out by one of Medicare’s contractors.

The second story comes from the United Kingdom.

Regular readers know that the government-run healthcare system in the United Kingdom is an ongoing horror story of denied care, sub-standard care, and patient brutality (click here to see some sickening examples).

You would think the U.K.’s political class would respond by trying to use money more effectively.

You would be wrong. The bureaucrats somehow have decided that tax monies should be used to finance a sperm bank, even though private sperm banks already exist.

Here are some excerpts from a report in the Daily Mail.

Britain is to get its first NHS-funded national sperm bank to make it easier for lesbian couples and single women to have children.For as little as £300 – less than half the cost of the service at a private clinic –  they will be able to search an online database and choose an anonymous donor on the basis of his ethnicity, height, profession and even hobbies. …The National Sperm Bank will be based at Birmingham Women’s NHS Foundation Trust, which currently runs an existing NHS fertility clinic and recruits sperm donors from the local population. Funded by a £77,000 Government grant, the bank will be run by the National Gamete Donation Trust (NGDT) which this year received  an additional £120,000 of public money to organise egg and sperm donation.

Some have criticized the initiative because it will purposefully increase the number of fatherless children.

…the move – funded by the Department of Health – is largely designed to meet the increasing demand from thousands of women who want to start a family without having a relationship with a man. Critics last night called it a ‘dangerous social experiment’ that could result in hundreds of fatherless ‘designer families’. …Ms Witjens rejected suggestions that children suffer adverse consequences from lacking a father figure. …Ms Witjens pointed to the removal of the reference to a ‘need for a father’ in the Human Fertilisation and Embryology Act, when taking account of a child’s welfare when providing fertility treatment.

I’m sympathetic to the argument that children do best in conventional households with fathers, but my main reaction to this story is that government shouldn’t try to either penalize or subsidize unconventional households.

And a government-sponsored sperm bank definitely falls into the latter category.

But I’m not surprised. Governments love to squanders other people’s money, and the U.K. government has considerable expertise (if you can call it that) in this regard.

Heck, the U.K. healthcare system is even financing boob jobs. But we’re not talking about reconstructive surgery for women who had mastectomies. They pay for breast augmentation for women who claim “emotional distress.”

Though maybe the U.K. government deserves a special prize. It developed a giveaway program that was so convoluted that nobody signed up to take the money.

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It’s difficult being a libertarian.

In addition to all the other challenges (such as trying to convince people stealing doesn’t become okay simply because the government is the middleman), I get conflicted about government waste.

You’re probably thinking I’m wandering off the libertarian reservation. After all, aren’t libertarians big opponents of boondoggles, government waste, and pork-barrel spending?

All true, but here’s my challenge: I also don’t want “efficient government.”

In other words, our goal should be to shrink government, not to make it “work better.” To understand the point I’m making, ponder these questions:

Do we want government to efficiently lure people into dependency?

Do we want government to efficiently socialize health care?

Do we want government to efficiently cartelize the agriculture sector?

I hope the answer to all these questions is “NO,” which is why I generally focus my work on structural changes to shrink the size and scope of government.

But every so often, notwithstanding everything I just wrote, I can’t resist pointing out really absurd examples of wasteful spending. And today we have two jaw-dropping examples.

We know that government bureaucracies like palatial buildings and that cost overruns are the rule rather than the exception. Well, one of the new bureaucracies created by the Dodd-Frank bailout bill is setting records for extravagance with its new headquarters.

The newly created Consumer Financial Protection Bureau is renovating the Washington, D.C., headquarters it rents—at a cost per square foot that is more expensive than Trump World Tower in New York City. The CFPB project is estimated to cost taxpayers more than $215 million… Cost projections have increased $65 million in six months and $120 million since last year’s estimate. Some of the building’s extravagant features include a four-story glass staircase, two-story waterfall and a sunken garden.

But what’s really amazing is that all this money is being spent on a rented building and that the cost of renovating is far greater than what was spent on building (yes, building, not just renovating) some of the world’s most famous landmark structures.

Now for our second example.

We’ve all heard about how big chunks of education spending get wasted on bureaucracy and don’t get used for classroom instruction.

And we read about how welfare bureaucrats consume a lot of money that supposedly is targeted to help poor people.

This principle also applies to other forms of government spending.

CNN reports that the federal government’s program for emergency food aid around the world is such a cluster-you-know-what that barely a bit more than one-third of money is actually spent on food for crisis-stricken regions.

International typhoons, hurricanes, and earthquakes leave behind devastating scenes of poverty and need. If you had about a $1.5 billion every year to send food to such desperate areas, how would you do it? …The way the U.S. provides international food aid is an antiquated and bureaucratic tangle. Food largely has to be purchased here in the U.S., and then shipped on boats by U.S. cargo carriers to the trouble spots. The Government Accountability Office says that 65% of the money for this aid program is spent on shipping and business costs – not on food. … it’s a system that has helped shipping companies and unions win billions in government contracts, companies like Maersk. …There’s also the transport workers unions. …The two leading maritime unions gave more than “three quarters of a million dollars to members of the current House of Representatives in the 2012 election cycle,” according to the Center for Public Integrity.

Geesh, what a typical example of insider corruption.

This is yet another piece of evidence for my view that disaster relief is not a function of the federal government.

P.S. Regarding the theme of today’s column, Fred Smith, the founder and former President of the Competitive Enterprise Institute, told me on more than one occasion that we should “be thankful we don’t get all the government we pay for.”

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Since I’ve already created a Moocher Hall of Fame to acknowledge the strangest and most reprehensible examples of government dependency, it’s occurred to me that there also should be a Bureaucrat Hall of Fame to highlight the government employees that have figured out how to most successfully rip off taxpayers (and here are some good candidates for charter membership).

But what if an entire bureaucracy was eligible?

The paper pushers at the Veterans Administration sure have figured out how to milk the system. Check out these excerpts from Associated Press report.

Nearly 80 percent of senior executives at the Department of Veterans Affairs got performance bonuses last year despite widespread treatment delays and preventable deaths at VA hospitals and clinics, a top official said Friday. …Workers at the Phoenix VA Health Care System — where officials have confirmed dozens of patients died while awaiting treatment — received about $3.9 million in bonuses last year, newly released records show. The merit-based bonuses were doled out to about 650 employees, including doctors, nurses, administrators, secretaries and cleaning staff.

This is such an outrageous waste of money that even the politicians who created it feel it should be criticized.

Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, said the VA’s bonus system “is failing veterans.” Instead of being given for outstanding work, the cash awards are “seen as an entitlement and have become irrelevant to quality work product,” Miller said. Rep. Phil Roe, R-Tenn., said awarding bonuses to 80 percent of executives means that the VA was setting the bar for performance so low that “anybody could step over it. If your metrics are low enough that almost everybody exceeds them, then your metrics are not very high.” Rep. Ann McLane Kuster, D-N.H., said the VA suffered from “grade inflation, or what (humorist) Garrison Keillor would refer to as ‘all of the children are above average.'” Kuster and other lawmakers said they found it hard to believe that 80 percent of senior employees could be viewed as exceeding expectations, given the growing uproar over patients dying while awaiting VA treatment and mounting evidence that workers falsified or omitted appointment schedules to mask frequent, long delays. …Miller, the panel’s chairman, noted that in the past four years, none of the VA’s 470 senior executives have received ratings of minimally satisfactory or unsatisfactory, the two lowest ratings on the VA’s five-tier evaluation system.

But the real lesson is that government simply doesn’t work very well

Or let me rephrase that. Government works very well…but only if you’re a politician, lobbyist, contractor, bureaucrat, or some other insider who has figured out that “the public sector” is a great way to obtain unearned wealth.

If you’re a taxpayer, by contrast, you get the short end of the stick (I was thinking of another analogy, but decided to keep things clean).

And if you’re someone – like a veteran – who is relying on government, then you’re in a very unfortunate position (sort of like the person in the other analogy that crossed my mind).

The main thing to understand is bureaucrats respond to incentives. And when you have government programs with no bottom-line reason to  deliver efficiency and good service, we shouldn’t be surprised that we get bloated payrolls and absurd compensation packages.

This video explains that it’s a government-wide phenomenon.

And to close out today’s column, here’s a Steve Kelley cartoon about Forrest Gump and the VA.

P.S. Don’t let politicians and interest groups get away with claiming that “inadequate funding” caused the VA scandal.

P.P.S. And grit your teeth because the government-run veterans health system is a good predictor of what we’ll all experience if the government-run Obamacare system is fully implemented.

P.P.P.S. Don’t forget that bonuses for poor performance are standard operating procedure in Washington. The bureaucrats at the IRS have been rewarded with extra cash notwithstanding all the scandals.

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The politicians, bureaucrats, lobbyists and interest groups in Washington are hyperventilating that the federal gravy train may get sidetracked for a day or two by a shutdown fight between Republicans and Democrats.

I’m not sure why they’re so agitated. After all, the shutdown is really just a slowdown since only non-essential bureaucrats are sent home. And everyone winds up getting paid for those unplanned vacations, which is why the bureaucrats I know are crossing their fingers for a lengthy confrontation.

But that describes what may happen when the new fiscal year begins tomorrow. What’s been happening in recent days, culminating today, is a feeding frenzy of end-of-the-fiscal-year wasteful spending.

Here are some details from a Washington Post expose.

This past week, the Department of Veterans Affairs bought $562,000 worth of artwork. In a single day, the Agriculture Department spent $144,000 on toner cartridges. And, in a single purchase, the Coast Guard spent $178,000 on “Cubicle Furniture Rehab.” …All week, while Congress fought over next year’s budget, federal workers were immersed in a separate frantic drama. They were trying to spend the rest of this year’s budget before it is too late. …If they don’t, the money becomes worthless to them on Oct. 1. And — even worse — if they fail to spend the money now, Congress could dock their funding in future years. The incentive, as always, is to spend. So they spent.

If you’re a taxpayer, you’ll be especially delighted to know that the “use it or lose it” spending orgy is so intense that federal contractors have to cater lunches for their sales staff. Can’t have them away from their desks, after all!

It was the return of one of Washington’s oldest bad habits: a blitz of expensive decisions, made by agencies with little incentive to save. Private contractors — worried that sequestration would result in a smaller spending rush this year — brought in food to keep salespeople at their desks. Federal workers quizzed harried colleagues in the hallways, asking if they had spent it all yet. …“Use it or lose it” season is not marked on any official government calendars. But in Washington, it is as real as Christmas. And as lucrative. …In 2012, for instance, the government spent $45 billion on contracts in the last week of September, according to calculations by the fiscal-conservative group Public Notice. That was more than any other week — 9 percent of the year’s contract spending money, spent in 2 percent of the year.

The IRS may win the prize for the most egregious example of last-minute waste.

In 2010, for instance, the Internal Revenue Service had millions left over in an account to hire new personnel. The money would expire at year’s end. Its solution was not a smart one. The IRS spent the money on a lavish conference. Which included a “Star Trek” parody video starring IRS managers. Which was filmed on a “Star Trek” set that the IRS paid to build. (Sample dialogue: “We’ve received a distress call from the planet NoTax.”)

But it’s not just tax collectors who flush our money down the toilet in creative ways.

One recent study, for instance, found that information technology contracts signed at year’s end often produced noticeably worse results than those signed in calmer times. …they listed dumb things they had seen bought: three years’ worth of staples. Portable generators that never got used. One said the National Guard bought so much ammunition that firing it all became a chore. “When you get BORED from shooting MACHINE GUNS, there is a problem,” an anonymous employee wrote.

Impressive examples of waste, though I confess I’m curious about the part about ammo and the National Guard. Does this mean bullets are like milk and have to be fired before an expiration date?

Beats me, but at least someone in the government acknowledged that (at least up to a point) it’s cool to fire a machine gun. Maybe that person should hook up with the Texas cop who likes tanks.

Oh, and you’ll be happy to know that spendaholic bureaucrats and crafty interest groups keep track of time zones so they can squander money until the very last second.

On Monday, Richer’s people will sell until midnight. Then they will keep selling. “Money rolls across the continent,” the feds say. Cash not spent in Washington might be spent by federal offices in California in the three hours before it is midnight there. When it is midnight in California — 3 a.m. in Washington — they will keep on. There are federal offices in Hawaii, after all. And it will still be three hours until midnight there.

Makes me think that we may need a slogan for the bureaucracy. Perhaps this modification of the Postal Service’s unofficial motto: “Neither snow nor rain nor heat nor gloom of night – nor even different time zones – stays these bureaucrats from spending every possible penny of other people’s money.”

But let’s close on an upbeat note. Whether you give credit to the Tea Party, to Republicans, to gridlock, or to Obama, the good news is that the federal government in the past two years has been wasting money at a slower rate.

So taxpayers can smile…or at least not frown as much. The bureaucracy and contractors may be throwing a party today, but not with the same reckless abandon they displayed between 2001 and 2010.

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What do you do if you’re part of a government bureaucracy that has been caught red-handed engaged in sleazy, corrupt, and (almost surely) illegal targeting of Americans for their political beliefs?

But before you answer, keep in mind that your bureaucracy also has been exposed for wasting huge amounts of money at lavish conferences. What’s the ideal way of dealing with the fallout from that scandal as well?

The answer is simple. Even though you and your pals already are paid more than the peasants in the private sector, give yourself and your cronies giant bonuses!

I’m not joking. Here are some excerpts from an AP report.

The Internal Revenue Service is about to pay $70 million in employee bonuses despite an Obama administration directive to cancel discretionary bonuses because of automatic spending cuts enacted this year, according to a GOP senator. …“The IRS always claims to be short on resources,” Grassley said. “But it appears to have $70 million for union bonuses…” Three congressional committees and the Justice Department are investigating the targeting of conservative groups. And key Republicans in Congress are promising more scrutiny of the agency’s budget, especially as it ramps up to play a major role in implementing the new health care law.

Sort of makes this cartoon self evident.

IRS Trust Cartoon

Indeed, this motivates me to announce “Mitchell’s First Theorem of Government.”

I’ve explicitly expressed this sentiment in the past, and hinted at it here, here, and here.

Now it’s time to make it official.

Mitchell's First Theorem of Government

I hope you’ll agree this is a nice addition to Mitchell’s Golden Rule, Mitchell’s Bleeding Heart Guide, and Mitchell’s Law.

And maybe one of these will catch on and I can be famous like Art Laffer.

P.S. Enjoy some cartoons about the IRS scandals here, here, and here.

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Taxpayers all across America send lots of money to Washington, DC, in part because we’re supposed to believe that redistribution is a legitimate and desirable function of the federal government.

But this is a very perverse form of redistribution. All that money going to Washington helps subsidize a network of overpaid bureaucrats, fat-cat lobbyists, corrupt politicians, and well-heeled interest groups.

Indeed, as shown in this map, 10 of the 15 richest counties in the country are in the Washington metropolitan area.

One of those wealthy areas is Arlington County, VA, just across the river from Washington. Home to thousands of federal bureaucrats and other DC insiders, Arlington is similar to Washington in that there is a lot of wasteful spending. Sort of makes you wonder if local bureaucrats and federal bureaucrats ever meet at bars after work and brag about who wasted the most money that day?

Anyhow, here are some sordid details from a Washington Post story.

A wall made of etched glass opens the rear vista to newly planted landscaping. Embedded in the floor are heating elements intended to ward off the cold weather and keep winter-weary feet cozy. …And the price tag: $1 million. “Is this made of gold?” asked commuter Yohannes Kaleab, examining the concrete-and-stainless-steel bench that is part of the new, seven-figure bus shelter. “What?” asked Robin Stewart as he learned of the cost of the structure while waiting for a bus there last week. “That’s ridiculous. From a citizen, from a voter, whoever put that budget through needs to get their butt canned. It’s an outrage.” The “super stop,” which opened March 11, is the first of 24 new bus stops that will also accommodate Arlington’s long-planned streetcars. …It will shelter 15 people at a time.

Boondoggle Bus Stop

$1 million for this bit of glass, metal, and concrete?!?

That sounds kind of expensive, but we can be comforted by the fact that thoughtful public servants predict future savings.

“When you do a prototype, you end up heavily front-loading on the costs,” said Dennis Leach, Arlington’s transportation director.

So how much will taxpayers save on the remaining 23 stops? Well, the good news is that they won’t cost $1 million each. The bad news is that the government doesn’t exactly save a lot of money when doing bulk purchases.

“Our goal if at all possible is to do it for less,” Leach said. The county has budgeted $20.8 million for the remaining 23 stops, or about $904,000 for each one.

Gee, knock me over with a feather. The additional bus stops will “only” be $904,000!

That’s not counting cost overruns, which are an inevitable reality with government budgeting, so I think it’s safe to assume that the final cost will be far higher.

So why do governments waste money like this?

Part of the answer, of course, is that politicians are inherently wasteful. But there’s another factor at play. Politicians are especially wasteful when they can spend money that isn’t collected from their own taxpayers.

And readers from other parts of America doubtlessly will be overjoyed to learn that their paying for a big chunk of this boondoggle.

Federal and state transportation money paid 80 percent of the costs.

With taxpayers outside of Arlington paying such a high share of the cost, we should think of ourselves as lucky that the bus stop didn’t cost $10 million!

But here’s the most amazing part of the story.

What’s the most important part of a bus stop? In theory, a bus stop can be nothing more than a sign indicating the spot where you should wait for a bus.

But if you’re going to build a structure, the most valuable feature – at least from the perspective of riders – is that you will be protected from the weather. So what sort of protection are riders getting as a result of this $1 million boondoggle? Meh, not so much.

…the bus shelter is “pretty, but I was struck by the fact that if it’s pouring rain, I’m going to get wet, and if it’s cold, the wind is going to be blowing on me. It doesn’t seem to be a shelter. It doesn’t really shelter you very much . . . you can get pretty soaked in two minutes.” Her opinion was shared by some on Columbia Pike trying it out.

Gee, isn’t this wonderful. Some contractors doubtlessly lined their pockets building this white elephant. Some consultants doubtlessly fattened their bank accounts with all the nonsense that is now part of the “planning” process.

But taxpayers, as usual, got the short end of the stick. They got taken for a ride, figuratively. And if they actually use the bus stop, they can get taken for a ride, literally, so long as they don’t mind getting wet.

P.S. And let’s not forget that Obama wants some more class-warfare tax hikes to finance more of this “investment.”

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I’ve been against the auto bailout from the very beginning because it was a corrupt payoff to lazy corporate fat-cats and an ossified union.

And when folks on the left say the bailout is a success, I explain that any industry can be propped up with a sufficiently large injection of other people’s money.

Now we have new data on how much “other people’s money” has been diverted. It’s a big number, and it seems to get bigger each time there’s a new estimate. Here’s part of a Reuters report.

The U.S. Treasury Department has said the auto industry bailout will cost taxpayers $3.4 billion more than previously thought. Treasury now estimates the 2009 bailout will eventually cost the government $25.1 billion, according to a report sent to Congress on Friday. That is up from the last quarterly estimate of $21.7 billion.

Sort of reminds me of the old joke about the lousy businessman who says he loses money on every sale, but he makes up for it with high volume.

Well, that incompetent businessman has a kindred spirit in the White House. Here’s some of what Politico reported.

President Obama, while villifying Mitt Romney for opposing the auto industry bailout, bragged about the success of his decision to provide government assistance… he said. “Now I want to do the same thing with manufacturing jobs, not just in the auto industry, but in every industry…”

Well, we can’t say we haven’t been warned. He wants to do the same thing in “every industry.” Well, according to the Bureau of Economic Analysis, there are 60 industries in America. At $25 billion each, that means $1.5 trillion.

Stimulus in action

By the way, Mickey Kaus explains that the government’s numbers are incomplete and that the actual damage is significantly higher. And this Reason TV video exposes some of the government’s chicanery.

P.S. If you’re in the mood for some satire, here’s a bailout form showing how you can become a deadbeat and mooch off the government.

P.P.S. Just in case you’re new to this blog and don’t know my history, rest assured that I’m also against Wall Street bailouts.

P.P.P.S. Ethical people should boycott GM and Chrysler, particularly since these companies are now handmaidens of big government.

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