Education, Accountability, and Miracles

Today's offering is kind of a hodge-podge of topics, but with the common thread of DME, of course.

A Little Education Can Go a Long Way
There's a campaign on to educate referral sources about competitive bidding. One person with whom I correspond said that he (or she, but for the sake of expedience we'll assign male gender) supports a new effort to educate about reporting problems, not about how to make the program work.

He said that in response to some questions that I posed: "Wouldn't it be more productive for the industry's purposes to not educate referral sources? Wouldn't it hasten the collapse of the program if there was more confusion (and not less)?"

I suppose that my pen pal is right and I'm wrong; one of his concerns seems to be that he thinks the referral sources, if not taken by the collective hand and given a crash course in problem reporting, simply won't bother. I'm not sure that I agree with that; if the beneficiaries aren't being properly served by DMEs, beneficiaries are sure to complain loud and long. And, since physicians have more power and influence than the DME industry does, if they're having to deal with upset patients, wouldn't it stand to reason that they'd make their displeasure with the bid program very clear?

Chaos is the score upon which reality is written. (Henry Miller)

Chaos in the world brings uneasiness, but it also allows the opportunity for creativity and growth. (Tom Barrett)

Sometimes chaos is a good thing. Chaos is almost always viewed in a negative light, but it has its place and can be extremely useful.

Accountability
We throw this word around all the time, but do we really know what it means?

accountability noun \ə-ˌkau̇n-tə-ˈbi-lə-tē\

Obligation of an individual, firm, or institution to account for its activities, accept responsibility for them, and to disclose the results in a transparent manner.

This word came up when I was having a conversation about CMS and its contractors. Neither that agency nor its contractors seem to understand the concept of accountability.

In our recovery package we put new standards of accountability and transparency, which we hope will now apply. (Nancy Pelosi)

We've all heard about the way financial institutions found ways around stipulations in the bail-outs they received; I think we all know how much government-mandated accountability is worth because of the loopholes built into legislation.

Government agencies have far too little accountability. This is true of virtually every agency, but definitely so with CMS.

Public record requests are virtually useless, and any claims to transparency are almost always misleading. Why? Because our idiot legislators, when making and passing laws, provide so many exceptions that can be interpreted so many ways that they and government agencies can evade public scrutiny.

This is definitely true of CMS. That agency has refused to provide the financial requirements of the competitive bidding program on the grounds that it may be "harmful."

Harmful to whom? To the bid winners? To the companies that didn't win contracts? Or would that information be harmful to the agency?

I feel an independent accountability commission should audit all government services. (Imran Khan)

Independent commissions are as independent as they are objective, which means, when I say that, that independent commissions are neither. When a commission is created, the appointments reveal the partisanship of the commission right at the very beginning. I've seen so-called bipartisan commissions, and there is always an agenda being served.

Restoring responsibility and accountability is essential to the economic and fiscal health of our nation. (Carl Levin)

As long as the endless number of exceptions to accountability remain, there is almost no hope for restoration. What we actually need isn't restoration; what we need is reform. But not the way lawmakers reform, because they always do an awful job.

Sometimes the only way to fix something is to dismantle it. The responsible approach to that would be to determine the course of action, put the systems in place, and then shut down the old.

CMS doesn't need reformed, because you can't reform something that's so huge and so completely out of touch. Legislators talk about health care "reform," and promise more "oversight" of agencies and programs.

How much "oversight" do you supposed CMS actually receives? I'm guessing not much, if any at all.

When it comes to privacy and accountability, people always demand the former for themselves and the latter for everyone else. (David Brin)

I think that a private individual is entitled to privacy (the very privacy our government very steadily takes from us in the name of "security"). But when a private individual becomes a civil servant (I include all government employees in that category, including the President of this country), we the people are entitled to expect transparency and accountability.

Without the enormous list of exceptions that serve only to permit them to hide what suits them from scrutiny.

Perhaps nothing in our society is more needed for those in positions of authority than accountability. Too often those with authority are able (and willing) to surround themselves with people who support their decisions without question. (Anonymous)

A Crash Course in Civics
The government of the United States is not a democracy. It is a democratic republic.

A republic is a political unit governed by a charter, while a democracy is a government whose prevailing force is always that of the majority. Our political unit (our government) is governed by a charter, which is the Constitution.

I think the primary difficulty in defining these two words — democracy and republic — stems from the fact that many people consider them to be synonyms, which they most definitely are not.

A direct democracy is one which is ruled entirely and directly by the people; to decide on an issue, the question is put to the vote of the population and the majority of those votes determine the outcome. In a representative democracy, citizens elect people to represent their interests in the government, and these representatives determine how issues are decided.

But our system is governed by a charter, and so the most accurate way to describe our government is a democratic republic.

We the people don't have the voice, the power, or the freedoms that we're led to believe that we have. We are fed the lie that the United States of America is a democracy through our schools and the propaganda the government issues.

The next time a legislator tells you that we live in a democracy, one of the following two things is the truth:

1. The legislator is deliberately lying to you; or
2. The legislator is as ignorant as the majority of the citizens of this country.

When you pledge allegiance to the flag of the United States of America, you also pledge your allegiance "to the republic for which it stands."

You don't pledge to the democracy for which it stands.

The majority does not rule here. In theory, that can be a good thing, because then the rights of the minority aren't overlooked. This can also be a bad thing, because too often the rights and opinions of the majority are overlooked (or ignored) because special interests prevail.

Which also erodes (or virtually obliterates) accountability.

Acts of God
The answer to the accountability question is one of size. CMS is like the DOD i[t]s so big it takes too long to discover a problem and then an act of God to fix it.

That's a direct quote from one of my readers with whom I chat relatively regularly. I don't know who he or she is, and I don't care to know. What I do care about is that this is a person who often makes good points and who, so far, appears to have been candid with me.

And that one statement shows how very wrong our government has gone and how little control we have over it. When a government agency is that big and can operate so badly with no accountability, it's time to start over.