Government – Page 43 – artdiamondblog.com

How Medicaid Rewards Doctors Who Mistreat Patients

(p. A13) I recently operated on a child with strabismus (crossed eyes). This child was covered by Medicaid. I was required to obtain surgical pre-authorization using a Current Procedural Terminology, or CPT, code for medical identification and billing purposes. The CPT code identified the particular procedure to be performed. Medicaid approved my surgical plan, and the surgery was scheduled.
During the surgery, I discovered the need to change my plan to accommodate findings resulting from a previous surgery by another physician. Armed with new information, I chose to operate on different muscles from the ones noted on the pre-approved plan. The revised surgery was successful, and the patient obtained straight eyes.
However, because I filed for payment using the different CPT code for the surgery I actually performed, Medicaid was not willing to adjust its protocol. The government denied all payment. Ironically, the code-listed payment for the procedure I ultimately performed was an amount 40% less than the amount approved for the initially authorized surgery. For over a year, I challenged Medicaid about its decision to deny payment. I wrote numerous letters and spoke to many Medicaid employees explaining the predicament. Eventually I gave up fighting what had obviously become a losing battle.

For the full commentary, see:
ZANE F. POLLARD. “The Bureaucrat Sitting on Your Doctor’s Shoulder; When I’m operating on a child, I shouldn’t have to wonder if Medicaid will OK a change in the surgical plan..” The Wall Street Journal (Thurs., May 22, 2014): A13.
(Note: the online version of the commentary has the date May 21, 2014.)

June 16th Is Liberalism Day

In the old days a “liberal” was someone who believed in freedom, including free markets and minimal government. Milton Friedman defended “liberal” in its original sense in his article “Liberalism, Old Style.”
At some point the left hijacked the word, at least in the United States. (I understand that in much of the rest of the world “liberal” still retains more of its original meaning.)
Maybe there’s some defensible justification for hijacking a word, but most of the time it seems like a dishonest and cowardly way to win an argument by muddying up the debate.
Dan Klein and Kevin Frei are trying to reclaim the word “liberal” from the pirates of the left. As part of their effort, they have proclaimed June 16th to be “Liberalism Day.”
I believe their cause is just, but I am not sure it is efficient. Time and effort are scarce, so we must pick our battles.
On the other hand, the meaning of “libertarian” has narrowed over recent decades. It used to be that most libertarians believed in minimal government; increasingly more libertarians endorse anarchism. It used to be that most libertarians believed in national defense; increasingly more libertarians endorse total isolationism.
I do believe in some minimal night-watchman state, and I do believe that sometimes there is evil in the world that must be fought. So maybe I should start calling myself a “liberal” in the original sense, what Friedman called a “classical liberal”?

#LiberalismDay

Federal Tax Reduction Fueled Craft Beer Revolution

Source of book image: online version of the NYT review quoted and cited below.

(p. 6) The story of craft beer’s rise begins in 1965, when Fritz Maytag, an heir to the Maytag appliance fortune, bought and revived the Anchor Steam brewery in San Francisco, thus inspiring a generation of so-called home brewers to begin considering commercial ventures.
. . .
A 1976 federal tax reduction for small brewers fueled the industry’s growth.
. . .
For years, the greatest challenge for craft brewers was distribution — simply getting restaurants and grocery stores to sell their product. Most wholesale beer distributors, Mr. Hindy writes, were heavily reliant on the three megabreweries — Anheuser-Busch, Miller and Coors — and couldn’t be bothered to spend time pushing obscure brands whose makers rarely had enough money to advertise. In 1996, Augustus Busch III demanded that its distributors devote a “100 percent share of mind” to Busch products. That left most microbrewers to beg and wheedle the Miller and Coors distributors, a situation so frustrating that, in time, Mr. Hindy’s Brooklyn Brewery began distributing its own products.

For the full review, see:
BRYAN BURROUGH. “OFF THE SHELF; Craft Brewers, Finding a Better Seat at the Bar.” The New York Times, SundayBusiness Section (Sun., MAY 11, 2014): 6.
(Note: ellipses added.)
(Note: the online version of the review has the date MAY 10, 2014.)

The book under review is:
Hindy, Steve. The Craft Beer Revolution: How a Band of Microbrewers Is Transforming the World’s Favorite Drink. New York: Palgrave Macmillan, 2014.

“A Backhanded Slap to Overweening European Union Rule Makers”

“Lemons sold by Ugly Fruit.” Source of caption and photo: online version of the NYT article quoted and cited below.

(p. 6) At a time of lingering economic hardship for many in the European Union, whose penchant for regulation has extended even to the shape, size and color of the foods its citizens eat, Ms. Soares has bet that there is a market for fruits and vegetables deemed too ugly by government bureaucrats, supermarkets and other retailers to sell to their customers.

Six months ago, she and a handful of volunteers started a cooperative called Fruta Feia, or Ugly Fruit, which in its short life is already verging on a kind of countercultural movement. It has taken off with hard-pressed consumers, won applause from advocates outraged by Europe’s skyrocketing food waste, and provided a backhanded slap to overweening European Union rule makers. In its own way, it has even quietly subverted fixed notions of what is beautiful, or at least edible.
“The E.U. norms are based on the mistaken idea that quality is about appearance,” said Ms. Soares, 31, who formerly worked in Barcelona as a renewable energy consultant. “It’s of course easier to measure the exterior aspect rather than interior features like sugar levels, but that is the wrong way to determine quality.”
She said her goal was “to break the dictatorship of aesthetics, because it has really helped increase food wastage.”
Europe wastes 89 million tons of food a year, according to a study presented in May by the Dutch and Swedish governments, which called on the European Union “to reduce the amount of food waste caused by the labeling system.”
For her part, Ms. Soares estimates that a third of Portugal’s farming produce goes to waste because of the quality standards set by supermarkets and their consumers. She says the waste is also a striking example of misplaced regulatory intervention by the European Union, which has tried to unify food standards across the 28-nation bloc.

For the full story, see:
RAPHAEL MINDER. “Tempting Europe With Ugly Fruit.” The New YorkTimes, First Section (Sun., MAY 25, 2014): 6 & 8.
(Note: the online version of the story has the date MAY 24, 2014.)

Government Regulations Favor Health Care Incumbents

Source of book image: online version of the WSJ review quoted and cited below.

(p. A11) The rise in U.S. health-care costs, to nearly 18% of GDP today from around 6% of GDP in 1965, has alarmed journalists, inspired policy wonks and left patients struggling to find empathy in a system that tends to view them as “a vessel for billing codes,” as the technologist Dave Chase has put it.

Enter Jonathan Bush, dyslexic entrepreneur, . . .
. . .
. . . , Mr. Bush touts technology as a driver of change. It has revolutionized the way we shop for books and select hotels, but health-care delivery has been stubbornly resistant. Mr. Bush notes that the number of people supporting each doctor has climbed to 16 today from 10 in 1990–half of whom, currently, are administrators handling the mounting paperwork. Astonishingly, as Mr. Bush observes, the government had to pay doctors billions of dollars, via the 2009 HITECH Act, to incentivize them to upgrade from paper to computers. Meanwhile, fast-food chains discovered computers on their own, because the market demanded it.
. . .
Let entrepreneurs loose on these challenges, Mr. Bush believes, and they will come up with solutions.
Mr. Bush identifies three major obstacles to the kinds of change he has in mind. First, large hospital systems leverage their market position to charge hefty premiums for basic services, then use the proceeds to buy more regional hospitals and local practices. “As big ones take over the small,” Mr. Bush laments, “prices shoot up. Choices vanish.” Second, government regulations, especially state laws, favor powerful incumbents, shielding “imaging centers and hospitals from competition.” Third, heath care suffers from a risk-avoidant culture. The maxim “do no harm,” Mr. Bush says, should not be an excuse for clinging to a flawed status quo.

For the full review, see:
David A. Shaywitz. “BOOKSHELF; A System Still in Need of Repair; Routine medical services can be done for less cost–one of many obvious realities that current health-care practices studiously ignore.” The Wall Street Journal (Mon., May 19, 2014): A11.
(Note: ellipses added.)
(Note: the online version of the review has the date May 18, 2014, and has the title “BOOKSHELF; Book Review: ‘Where Does It Hurt?’ by Jonathan Bush; Routine medical services can be done for less cost–one of many obvious realities that current health-care practices studiously ignore.”)

The book under review is:
Bush, Jonathan, and Stephen Baker. Where Does It Hurt?: An Entrepreneur’s Guide to Fixing Health Care. New York: Portfolio, 2014.

Public Cannot Go into Space Because of Government Run Space Programs

“‘You don’t have to be a rocket scientist to be able to run a spaceship company,’ says Richard Branson.” Source of caption and photo: online version of the WSJ article quoted and cited below.

(p. C11) Richard Branson, founder of the Virgin Group, is just months away from launching what he considers “the biggest Virgin company we’ve ever built.” At 63, he’s already founded multiple businesses worth billions, including a record label and a mobile company. But it’s his foray into outer space with Virgin Galactic that has Mr. Branson excited.
. . .
Safety has been one of the biggest challenges in building Virgin Galactic. In 2007, two workers died after a tank explosion during a rocket test, and three were seriously wounded. The accident, which occurred at a partner company’s facility, delayed the program for an estimated 18 months.
Risk factors weigh on the minds of potential customers as well, especially after NASA’s 1986 Challenger disaster, in which seven crew members, including a schoolteacher, died. Mr. Branson thinks that today most people would want to go into space if they could be guaranteed a safe return trip. “Sadly, I think because the space program was run by governments, there was never any real interest in enabling members of the public to go to space after they tried once” with the Challenger, he explains. “After that, they decided not to take any risks whatsoever.” He adds, “I would say 90% of people my age thought they would go to space because they saw the moon landing.”

For the full story, see:
ALEXANDRA WOLFE. “WEEKEND CONFIDENTIAL; Richard Branson; The Virgin Group founder on his out-of-this world venture: space travel.” The Wall Street Journal (Sat., Nov. 2, 2013): C11.
(Note: ellipsis added.)
(Note: the online version of the story has the date Nov. 1, 2013, and has the title “WEEKEND CONFIDENTIAL; Richard Branson on Space Travel; The Virgin Group founder on his latest out-of-this world venture, Virgin Galactic’.”)

“A Libertarian Celebration of Hustling, Hacking and Free-Form Development”

Source of book image: http://www.hmhco.com/shop/books/the-bright-continent/9780547678313#

(p. 21) Africa’s gains have come not because of Western largess or painful structural adjustment programs set out by the likes of the International Monetary Fund, Olopade argues, nor are they the work of governments. They are largely the fruit of Africans’ efforts to help themselves, through creative means that sometimes involve breaking the rules.
. . .
She excavates a hopeful narrative about a continent on the rise, “a libertarian celebration of hustling, hacking and free-form development.”
The best solutions, according to Olopade, are local, developed by people closest to the problem, not bureaucrats in Washington or Brussels: the South African gynecologist who operates out of two shipping containers stacked together, the Kenyan family who take over an abandoned plot of land to grow vegetables to eat and sell.
Central to Olopade’s thesis is the concept of kanju, a term that describes “the specific creativity born from African difficulty.” It is the rule-bending ethos that makes it possible to get things done in the face of headaches like crumbling infrastructure, corrupt bureaucracy and tightfisted banks unwilling to make loans to people without political connections.
Many countries have these kinds of hacks and workarounds. In India, the term is jugaad, and it has had its moment in the sun as a business school concept. India runs on this informal hacking of the system that makes life and business possible.

For the full review, see:
LYDIA POLGREEN. “Home Improvement.” The New York Times Book Review (Sun., APRIL 13, 2014): 21.
(Note: ellipsis added; italics in original.)
(Note: the online version of the review has the date APRIL 11, 2014, and has the title “Home Improvement; ‘The Bright Continent,’ by Dayo Olopade.”)

The book under review is:
Olopade, Dayo. The Bright Continent: Breaking Rules and Making Change in Modern Africa. New York: Houghton Mifflin Harcourt Publishing Co., 2014.

In France “‘Liberté, Égalité, Fraternité’ Means that What’s Yours Should Be Mine”

Guillaume Santacruz is among many French entrepreneurs now using London as their base. He said of his native France, “The economy is not going well, and if you want to get ahead or run your own business, the environment is not good.” Source of caption and photo: online version of the NYT article quoted and cited below.

(p. 1) Guillaume Santacruz, an aspiring French entrepreneur, brushed the rain from his black sweater and skinny jeans and headed down to a cavernous basement inside Campus London, a seven-story hive run by Google in the city’s East End.
. . .
A year earlier, Mr. Santacruz, who has two degrees in finance, was living in Paris near the Place de la Madeleine, working in a boutique finance firm. He had taken that job after his attempt to start a business in Marseille foundered under a pile of government regulations and a seemingly endless parade of taxes. The episode left him wary of starting any new projects in France. Yet he still hungered to be his own boss.
He decided that he would try again. Just not in his own country.
“A lot of people are like, ‘Why would you ever leave France?’ ” Mr. Santacruz said. “I’ll tell you. France has a lot of problems. There’s a feeling of gloom that seems to be growing deeper. The economy is not going well, and if you want to get ahead or run your own business, the environment is not good.”
. . .
(p. 5) “Making it” is almost never easy, but Mr. Santacruz found the French bureaucracy to be an unbridgeable moat around his ambitions. Having received his master’s in finance at the University of Nottingham in England, he returned to France to work with a friend’s father to open dental clinics in Marseille. “But the French administration turned it into a herculean effort,” he said.
A one-month wait for a license turned into three months, then six. They tried simplifying the corporate structure but were stymied by regulatory hurdles. Hiring was delayed, partly because of social taxes that companies pay on salaries. In France, the share of nonwage costs for employers to fund unemployment benefits, education, health care and pensions is more than 33 percent. In Britain, it is around 20 percent.
“Every week, more tax letters would come,” Mr. Santacruz recalled.
. . .
Diane Segalen, an executive recruiter for many of France’s biggest companies who recently moved most of her practice, Segalen & Associés, to London from Paris, says the competitiveness gap is easy to see just by reading the newspapers. “In Britain, you read about all the deals going on here,” Ms. Segalen said. “In the French papers, you read about taxes, more taxes, economic problems and the state’s involvement in everything.”
. . .
“It is a French cultural characteristic that goes back to almost the revolution and Robespierre, where there’s a deep-rooted feeling that you don’t show that you make money,” Ms. Segalen, the recruiter, said. “There is this sense that ‘liberté, égalité, fraternité’ means that what’s yours should be mine. It’s more like, if someone has something I can’t have, I’d rather deprive this person from having it than trying to work hard to get it myself. That’s a very French state of mind. But it’s a race to the bottom.”

For the full story, see:
LIZ ALDERMAN. “Au Revoir, Entrepreneurs.” The New York Times, SundayBusiness Section (Sun., MARCH 23, 2014): 1 & 5.
(Note: ellipses added.)
(Note: the online version of the story has the date MARCH 22, 2014.)

‘Diane Segalen moved most of her executive recruiting practice to London from Paris. In France, she says, “there is this sense that ‘liberté, égalité, fraternité’ means that what’s yours should be mine.”” Source of caption and photo: online version of the NYT article quoted and cited above.

Koch Industries Was Only Major Ethanol Producer to Oppose Ethanol Tax Credits

(p. A17) I have devoted most of my life to understanding the principles that enable people to improve their lives. It is those principles–the principles of a free society–that have shaped my life, my family, our company and America itself.
Unfortunately, the fundamental concepts of dignity, respect, equality before the law and personal freedom are under attack by the nation’s own government. That’s why, if we want to restore a free society and create greater well-being and opportunity for all Americans, we have no choice but to fight for those principles.
. . .
Far from trying to rig the system, I have spent decades opposing cronyism and all political favors, including mandates, subsidies and protective tariffs–even when we benefit from them. I believe that cronyism is nothing more than welfare for the rich and powerful, and should be abolished.
Koch Industries was the only major producer in the ethanol industry to argue for the demise of the ethanol tax credit in 2011. That government handout (which cost taxpayers billions) needlessly drove up food and fuel prices as well as other costs for consumers–many of whom were poor or otherwise disadvantaged. Now the mandate needs to go, so that consumers and the marketplace are the ones who decide the future of ethanol.

For the full commentary, see:
CHARLES G. KOCH. “OPINION; I’m Fighting to Restore a Free Society; Instead of welcoming free debate, collectivists engage in character assassination.” The Wall Street Journal (Thurs., April 3, 2014): A17.
(Note: ellipsis added.)
(Note: the online version of the commentary was updated April 2, 2014, and has the title “OPINION; Charles Koch: I’m Fighting to Restore a Free Society; Instead of welcoming free debate, collectivists engage in character assassination.” )

Koch’s philosophy of the free market is more fully elaborated in:
Koch, Charles G. The Science of Success: How Market-Based Management Built the World’s Largest Private Company. Hoboken, NJ: Wiley & Sons, Inc., 2007.

Delta Overcomes Obstacles that Ground Other Airlines

Source of graphic: online version of the WSJ article quoted and cited below.

Cancellations due to mechanical failures, piliot illness and government regulations are often announced as though they were acts of God, outside the possible control of airlines, for which the airline is blameless. But airlines can take actions, and improve processes, to reduce the frequency and consequences of such cancellations. In airlines, and in other firms, there is not a sharp line between what can and what cannot be under the firm’s control.

(p. D3) Atlanta

The crew of Delta Air Lines Flight 55 last Thursday couldn’t legally fly from Lagos, Nigeria, to Atlanta unless they waited a day due to new limits on how much pilots can fly in a rolling 28-day period. The trip would have to be canceled.
Instead, Delta headquarters told the captain to fly to San Juan, Puerto Rico, which they could reach within their duty limits. There, two new pilots would be waiting to take the Boeing 767 on to Atlanta. The plane arrived in San Juan at 2:44 a.m., quickly took on fuel and pilots, and landed in Atlanta only 40 minutes late.
The episode, unorthodox in the airline industry, illustrates the fanaticism Delta now has for avoiding cancellations. Last year, Delta canceled just 0.3% of its flights, according to flight-tracking service FlightStats.com. That was twice as good as the next-best airlines, Southwest and Alaska, and five times better than the industry average of 1.7%.
. . .
Managers in Delta operations centers move planes, crews and parts around hourly trying to avoid canceling flights. How well an airline maintains its fleet and how smartly it stashes spare parts and planes at airports affect whether your flight goes or not.
Delta thinks it has come up with new analytical software and instruments that can help monitor the health of airplanes and predict which parts will soon fail. Empty planes are ferried to replace crippled jets rather than waiting for overnight repairs.
Mechanics developed a vibration monitor to install on cooling fans for cockpit instruments. A plane can’t be sent out on a new trip with a broken fan.
Now when vibration starts to increase, indicating that a bearing may be wearing down and getting close to failing, a new fan is swapped in. The wobbly fan goes to the shop for new bearings. That has reduced canceled flights.
So has spending $2 million to have spare starters for Boeing 767 engines at all 767 stations abroad. Starters last about five years. While each plane has two and both engines can be started with one, you can’t send a plane out on a long trip over oceans with only one working.

For the full story, see:
SCOTT MCCARTNEY. “THE MIDDLE SEAT; A World Where Flights Aren’t Canceled; How Smartly an Airline Stashes Spare Parts and Planes at Airports Affects Whether or Not Your Flight Takes Off.” The Wall Street Journal (Thurs., April 3, 2014): D3.
(Note: ellipsis added.)
(Note: the online version of the story was updated April 2, 2014, and has the title “THE MIDDLE SEAT; A World Where Flights Aren’t Canceled; Inside Delta’s new strategies to avoid stranding fliers.”)