Wednesday, May 21, 2014

A Broken Promise: Failures of Bureaucracy

Veterans Affairs Secretary Eric Shinseki is under fire on Capitol Hill today over the ineffectiveness and breakdown in common integrity within the department.  Records and revelations now indicate that the following events have occurred:
-       Off the record lists were kept of veterans waiting for excessive periods of time for care.
-       Up to 40 veterans died while waiting to get an appointment.
-       Staff at the medical care facility in Ft. Collins, Colorado was urged to falsify records to cover up the lengthy wait periods that fell outside of the department’s goal of 14 days.
-       Screenings for colon cancer were delayed resulting in 50 patients receiving a delayed diagnosis of colon cancer.

I’m certain that this short list is not exhaustive of the mismanagement within the Department of Veterans Affairs.  Nor does it reflect on all of the quality medical care that is provided to veterans on a daily basis, the timely payment of pensions, and the management of the national cemeteries.

Instead, I would prefer to pursue a different set of questions. 

First, let’s look at the size and scope of the Department of Veterans Affairs.  A quick check of the Department’s website reveals the Secretary Shinseki is responsible for the following organizations and facilities:
-       820 outpatient clinics
-       300 veterans centers
-       150 hospitals
-       131 national cemeteries
-       56 regional offices
-       3 different administrations
-       Over 275,000 employees (as of 2009)

With multiple responsibilities and facilities throughout the United States, the scope of the Department is massive.

Now to the questions:

-       At what point does a bureaucracy become too large to manage effectively?
-       At what point does a bureaucracy become so large that change becomes unlikely?
-       At what point does a bureaucracy become so large that it is foolishness to think that we can hold one person accountable for everything that is happening?

Government bureaucracies are interesting things.  Originally they are created to solve or address a specific problem or need.  Once a bureaucracy is in place it is a simple matter to give it increased responsibility in different areas rather than set up a new bureaucracy.  Government bureaucracies, like some banks, reach a point in size and scope, where they no longer have to justify their existence based on the need for their services or their effectiveness.  Rather, they justify their existence by the fact that they exist and employ and impact thousands or millions of people. 

Bureaucrats in large bureaucracies begin to lose sight of the original purpose of the organization.  Partly this stems from the fact that their ability to control events diminishes as the bureaucracy grows.  Focus shifts from problem solving and rendering services to ensuring the continued existence and growth of the organization.  This mentality begins to exist on its own within the abstract structures of the institutions.  Individuals with seeming authority speak out against the uncontrollable nature of the beast but recognize they are powerless to stop it.

At the end of the day, Eric Shinseki is not fully accountable for what happened at the VA.  His ability to see what was happening and to affect it is minimal.  He happened to be the person in charge when this set of unfortunate news came to light.  He or his replacement may be able to make some real changes after in the aftermath of this process, changes that may improve care and resurrect integrity.  Those changes will be temporary.  The changes will result in new bureaucrats, new rules, and new organizations that will continue to push the department beyond the scope of human control and understanding.

Accountability for this fiasco lies with the American people.  We have accepted as fact that a large, non-personal, non-accountable public entity will do what we created it to do.  We fail to see that at some point government agencies begin to exist for themselves.  Effectiveness, efficiency, and honesty are the casualties of gargantuan government agencies.

The promise that government in such a size can take care of us effectively has yet to be proven.  Some will say, “Well, the good outweighs the bad.  By and large these agencies do a good thing.”

What do we do when the good no longer outweighs the bad?  What do we do when the agency is no longer within the control of the taxpayer, the voter, the politician, or even the bureaucrat?

Here’s what we do, at least in the case of the Department of Veterans Affairs: We allow people who served our country to suffer and die needlessly. 

Of course, not all government mismanagement results directly in death.  Targeting and political agendas in the IRS, whatever the scope, probably didn’t kill anyone directly. 

One more question: As we look at what has happened within the Department of Veterans Affairs, what do we think is going to happen with the full implementation of the Affordable Care Act or if we go to a single payer system administered by the government?

Like Secretary Shinseki, I’m “mad as hell” to find out that our veterans have suffered and died needlessly.  Also like Shinseki, I’m largely powerless, by myself, to do anything to have prevented it.

Tuesday, May 20, 2014

Pathways to Fairness and Equity: Building Unity through Societal Division

A fresh morning breeze blew down Main Street, lifting a few dry leaves from the road. 

All seemed good in the small town—but it wasn’t so.  Mayor Roberts had scheduled a meeting to address the issue for that very day.  City council members, community leaders, and other interested individuals made their way into City Hall. 

The Honorable Mayor Jenny Roberts began the meeting with the customary oratory.

“Friends and fellow citizens!  Welcome to City Hall.  The Carroll City Council Meeting is now in order.  We are meeting today in order to discuss the most serious issue facing us as a community.

“How do we ensure that every citizen is treated fairly and equally?”

A low murmur ran through the crowd.  People began to share their thoughts with each other on the issue at hand.  Banging her gavel on the podium, Mayor Roberts brought the room back to order.

“Let’s review the situation, the cause of our greatest problems.

“First, our dairy farmers on the edge of town get the freshest milk and butter.  The rest of us, except for a few of their choice neighbors, get only processed dairy products.  We must pay more for our dairy products and suffer through the incessant smell of cow manure.

“Second, the owners of our three construction companies live in large, luxurious homes that were built using the profits made from the construction of our homes, schools, and other buildings.  For many of you, your homes are smaller than theirs and you must pay for regular repairs and maintenance.

“Third, our local restaurant, café, and grocery store owners are able to buy their food at wholesale.  They buy food for their own families at wholesale, and then sell it to us at retail.”

At these remarks, a murmur once again began to build among those in attendance.  With a vigorous pounding of the gavel order was almost restored, until someone yelled out loud.

“What about all those potato farmers?  I was talking to one of them the other day.  His family gets all the potatoes they want, but he charged me $25 for a 50 pound bag.”

Clearing her throat, Mayor Roberts glared at the citizen.

“I was getting to that.  We have potato farmers and other farmers who get their own vegetables and grains straight from their fields.  We either have to buy it directly from them or from the grocery stores after its been processed and gone up in price.

“Fifth, our cadre of doctors and nurses in our community and at our small hospital charge us and our insurance companies to provide us medical care.  Based on the cars they drive, they must charge more than enough.  Plus, we haven’t been able to ascertain how much, if anything, they pay for their own medical care.”

Looks of concern, agitation, and anger flitted across all the faces in the room.  Everything seemed out of balance.  All of them in attendance were aware of these problems.  They brought it to the attention of Mayor Roberts and the City Council on a regular basis.  While they enjoyed hearing about others sharing in their suffering, they had gathered on this day to hear a solution.

“What will we do about it,” someone shouted.

With a profound look on her face, Mayor Roberts stated, “After careful deliberation we have conceived of a mechanism for measuring fairness and equality.  The plan includes methods for restoring balance between all of us.  Councilmember Reid will address us first.”

Councilmember Scott Reid slid his chair back from the table.  His gray hair and dark suit projected an image of respectability and trustworthiness.

“Ladies and gentleman,” he boomed into the microphone.  “The first step in our process will be to set up a method whereby we may measure fairness and equality.  We will divide the citizens of our city up into easily identifiable demographic groups.  The initial list of groups will include the following: agriculturists (farmers and ranchers), large business owners, small business owners, professional healthcare providers, government employees, and laborers.  Additional groups will be added as it becomes necessary or desirable.”

A chair slammed to the floor in the back of the room as a gentleman jumped to his feet.

“What about those of us who aren’t working?  Will we get our own designation as well?  You have to compare me to everyone else to make sure we get what is fair.”

“Calm down.  Calm down,” yelled Councilmember Reid.  “Let me pencil that in right here…unemployed.  See how easy that was to add a group.”

Shuffling his papers, Councilmember Reid moved on in his presentation.

“Once everyone is divided up into easily identifiable groups, we will proceed to measure their income, their wealth, and their property.  This will allow us to determine who has more and who has less.  Based on these measurements we will divide everyone up into a separate grouping based on class, or economic well-being.

“At a minimum we will have the following divisions based on class: poor, lower middle class, middle class, upper middle class, and upper class.

“It is likely that we will find that certain of our easily identifiable groups will largely fall into the same class divisions.  In order to perpetuate the use of these easily identifiable groups we will celebrate the existence of those groups that seem naturally to fall into a class division that is struggling.  This will remind us of our inequalities and the need make corrections.”

Finished, Councilmember Reid returned to his seat.  Mayor Roberts quickly turned the time over to Councilmember Jarius Roberts, her son.

“Ladies and gentlemen,” squeaked Councilmember Roberts, “my mother, I mean Mayor Roberts, has asked me to explain to you the next step in our plan to foster fairness and equality.  With the division made and measurements of wealth completed we will make a thorough comparison between the various groups.  As we identify inequities we will adjust policies to correct them.

“For example, it is likely that we will require that dairy farmers be required to turn their entire daily milk harvest over to the processor.  They will not be allowed to keep any for themselves.  Instead they will have to buy all of their dairy products from the store just like the rest of us.

“In order to conduct measurements and enforce fairness and equity policies, we will increase the size of the assessor’s and constable’s offices by 20%.  Additional increases in staffing will be added as necessary.”

Mayor Roberts stood to give her closing remarks.

“Fellow citizens, let us press forward in our honorable goal to establish fairness and equality in our small town.  As we label our citizens and measure their wealth we will better be able to unify our community.  By pulling some down and lifting others up we hope to find common ground that will meet the needs of everyone!”

Ogden Marathon 2014: Oops, I Did It Again!

This is a secret blog post.  I’m hoping my wife doesn’t find this, at least not anytime soon.  Last year I wrote about my experience running the Ogden Marathon in the rain and with minimal training.  As I crossed the finish line last year I vowed that I would run it again with more training.  Alas, personal weakness pulled me down this year.  I could mention increased stress at work, a new church calling with increased responsibilities, and the exhaustion of having six wonderful children…but they would just be excuses to cover my weakness.  

Jeff photobombing my selfie

Really the reason for my failure to train this year for any of my races comes down to a desire to sleep in and to watch television in the evenings. My wife has threatened me if I try to run the marathon again without training.

As the date for the Ogden Marathon approached, I again had friends and family reminding me that the date was approaching.  In the forefront of my mind was the desire and idea simply to not show for the race.  The subject of not running was broached with my father, six months back from his deployment.  With his limited training I hoped that maybe he would ratify my suggestion thus saving us significant pain and discomfort.  Three weeks prior to the race, however, he called to inform me that he had reserved our rooms at our secret lodging facility.  He said I was committed.

The bulk of my training this year consisted of some regular running in early April prior to the Ragnar Zion Trail Relay and the actual running of the relay.  Unfortunately during the trail relay I only finished two of the legs due to the weather.  Not only was I denied 8.2 miles of training, I managed to crash into the ground during my night run injuring my back.

With a recovering back and one more short run, I packed my running gear and my two boys into the car.  We left Thursday before the race for Provo to stay at my parents.  Friday afternoon, in the midst of an effort to complete the sale of our house in Colorado Springs (for which my wife did most of the work), my dad, Jeff, and I left Utah Valley for Ogden and Huntsville.

Port-a-Potty Village, aka The Starting Area
The location for the Ogden Marathon Expo this year was amazing.  Runners, volunteers, and others were well served by the Weber County Sports Complex on the campus of Weber State University.  Parking was a cinch and packet pick up ran smoothly.  For a few minutes I managed to forget the pending doom hung over me by my lack of training.

Driving up Ogden Canyon to our secret lodging facility, I couldn’t help but think of all the emotion and pain I had felt in previous years coming down that canyon.  With a herculean effort I regained control of my thoughts as they attempted to stray into the realm of “what’s going to happen tomorrow.”  At that point my ability to change anything through training was gone.  It was time to accept simply what was going to be—to be prepared to make the best of it.

Sleep evaded me for several hours that night, partly due to nerves and partly due to my extra efforts to hydrate during the day.  Eventually sleep overcame me and I was pulled out of a dream by my alarm.  Within a few minutes I was gathered with other runners in the dining area for an excellent meal.  The buses were almost 30 minutes later than normal picking us up this year in Huntsville.  It made for a shorter wait in the cold at the start line but also prevented me from cycling through the outhouse lines to relieve myself of pre-race jitters.

I ran with my dad for the first 10 miles with the hope that we could push each other to cut-offs in time and ultimately to the finish line.  Still on antibiotics for strep throat and suffering with congested lungs, he had a tough go of it.  Shortly after mile 10 he realized he may not make it to the halfway point in time to make it to the cutoff at the top of the dam.  With his encouragement, and a little bit of guilt, I left him behind.
Dad (Reed) and Jeff

As I came into Eden the day was starting to warm up (and by then the winner of the marathon had crossed the finish line in Ogden already).  Without a pause this year I pushed past the halfway point and up the hill.  Physically I still felt fine but I could feel my energy ebbing away.  From mile 15 on I had to force myself to eat when I could and to drink water and PowerAde.  I pushed some electrolyte pills and a few acetaminophen pills along the way.  Just under two miles from the dam I was secretly hoping that I wouldn’t make the cut off time.  A deputy sheriff drove by announcing that we had 40 minutes.  From there I knew that even walking I would make it to the finish line before they shut the course down.  Not an overly inspiring thought, but it kept me going.

The heat became a threat to my ability to continue forward.  I forced myself to continue hydrating.

Down the canyon I struggled to run at all.  I had no timing device with me this year, aside from my phone that was tucked away in a pouch.  Due to my extra slow pace this year a couple of the aid stations were out of oranges when I arrived.  Oranges keep me going when nothing else will.  The canyon, as always was beautiful, and it was a bit more solitary this year for me.

Once out of the canyon my ability to run for more than sixty seconds at a time was gone.  I pushed when I could but it wasn’t too often.  With two miles to go I caught up with a girl who had passed me earlier.  Her name is Heather.  She committed to keep up with my walking pace.  The conversation helped keep my thoughts off of the pain in my feet and the cramps in my legs.  Running would have felt better on my feet than walking, but I couldn’t muster the energy to sustain anything worthwhile.

Again, the interminable stretch down Grant bludgeoned my mental commitment.  In a desire to get it over I quickened my stride.  Finally, with a tenth of a mile to go, Heather and I ran.  We crossed the finish line together exchanging high fives.  While my finish time consists of numbers that are more than a bit embarrassing, finishing was grand as always.  

Across the finish line I struggled to think about what to do next.  Looking ahead I saw several of my Air Force brothers and sisters in their uniforms holding the medals.  I must have looked confused and dazed.  A young, female staff sergeant caught my eye.  She held it as she raised a medal in her arms for me.  Understanding came a bit slowly to me, but with my comprehension I pointed to her and limped the twenty or so yards so she could put the medal on my neck.

Two major lessons for this year:
1.     I can finish a marathon with almost no training.
2.     I shouldn’t try to run a marathon with almost no training

Other lessons:
1.     Sometimes lessons have to be taught multiple times before they are learned.
2.     People can do so much more than they think they can.
3.     Marathons are one of the most motivational events.

My dad finished his race at the halfway point in Eden.  Our friend Jeff finished in 4:40.  Prior to the race I told my dad that I likely would run only the half marathon next year due to my training schedule.  Looking back on the race now, I want to commit to running the full marathon for the sixth time.  In order to allow myself to register in October, I have set some strict goals that I must meet.  Basically, it comes down to running regularly (and it will mean running in Las Vegas during the summer).

Here’s to next year’s goal of qualifying myself to run the full Ogden Marathon and to improving my time.  (Let’s keep this on the down low from my wife for as long as possible.)