Some time ago I had occasion to represent a movie studio for a number of years, and in that context I came to learn of something in that business that they called the "fifteen picture rule." The rule held that it was difficult if not impossible for one studio successfully to produce more than about fifteen pictures per year. Many had tried, only to meet with failure for one reason or another -- either they just couldn't meet their production goals, or they would find themselves producing a lot of expensive flops. The rule was really a reflection of the limits on the time and attention of the top management talent needed to put together all the pieces that it takes to make a major movie. When the Japanese electronics giant Sony wanted to enter the Hollywood film business in a big way, it tried to get around the rule by buying two studios, Columbia and Tri-Star, thus having two management teams. Although they made more than fifteen pictures, they still were not a success at it.
Well, if a major movie is about a $100 million project, and the federal government is about a $3.5 trillion per year project, then we can think of the federal government as having undertaken to make the equivalent of about 35,000 movies per year with one top management team. What is the chance that this can work out well? Actually it's worse than that, because the chief executive of a movie business devotes nearly all of his time to the business of making movies, whereas the chief executive of the federal government starts out devoting half or more of his time to politics rather than operations -- speeches, fund raisers, press conferences. Then there's meeting with foreign leaders and being commander in chief of the armed forces. In the best of circumstances, how much time do the President and his top team have to devote to the actual operations of the domestic programs of the government? And finally, add to this mix having a guy as CEO who has never shown the slightest interest in the domestic operations side of the job.
Actual socialist governments that try to take on the job of running a whole economy deal with the fifteen picture limitation by devoting their limited time and attention to the things they deem most important. Inevitably that turns out to be the military and some form of secret police or palace guard to prevent revolutions and coups. No time left to figure out how to make housing or food? Too bad, the people can starve. Think Cuba or North Korea for a current example. In the old Soviet Union they had enough talent at least for a while to run a top-flight military, secret police (KGB), and a premier Olympic sports program. That's about where they ran out of focus. In the United States, with a huge capitalist system (thousands of independently-operating top management teams) we can generate a vast gusher of tax revenue for the government. With that they can accomplish the task of mindlessly passing the money around, but no way can they successfully run thousands of programs.
So now we have a massive VA healthcare bureaucracy in the classic government mode, where nobody at the top has any time to ride herd on them and there is no possibility of outsize rewards for anyone for making sure that the job gets done right. What could possibly go wrong? James Taranto at Best of the Web has the following from vox.com:
According to internal emails later acquired by CNN, VA managers in Phoenix created a secret wait list in an attempt to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor. Even worse, top-level management supposedly knew of and defended the practice. Besides the secret list, the Phoenix VA hospital already provided a different, official wait list to DC that allowed VA higher-ups to verify that patients are being treated in a timely manner (within 14 to 30 days). But Phoenix's secret wait list supposedly avoided federal oversight with an elaborate scheme in which officials shredded evidence that some patients were taking months to be seen. What's worse, if someone died while waiting for an appointment due to the secret wait list, Phoenix officials would allegedly discard the name as if the fatal error never happened.
And that, it appears, is just the tip of the iceberg. Taranto notes that the American Legion is tracking "issues with scheduling practices" in up to 18 states. I'll confidently predict that by the time this is over it will be 50. And do you think for a minute that our government's top management is doing any better job getting real performance out of the Department of Agriculture, or Education, or Energy, or HHS, or Labor, or Commerce? All of these are out-of-sight out-of-mind at the moment. And thus we give the bureaucracy $1 trillion per year to spend to alleviate poverty without making a dent in poverty.
The socialist delusion just will not die. Even as the VA scandal breaks, Vermont plows forward with its in-the-works "socialism in one state" single payer health care scheme. Here is a gushing, glowing write-up yesterday from MSNBC. The word "bold" appears at least half a dozen times. They're sure this will work because they hired a really, really smart "Harvard economist" (William Hsiao) to design it. And with one central payer, the administrative savings alone will be huge!
[Hsaio's] team found that if doctors and hospitals could submit claims to one central payer instead of dozens, the administrative savings alone would cut health care costs by 7% over 10 years.
Well, Professor Hsaio, with no private property North Korea has done away with the enormous expense of having lawyers like me to define property and contract rights. Why haven't those administrative savings brought it prosperity?
Perhaps the people from MSNBC should read Michael Totten's piece in the current City Journal, describing the Cuba existing today just outside its tiny bubble zones reserved for tourists. It's not just that the buildings are falling down and there is nothing to eat. Here's Totten's description of where Cuba's once touted health care has gotten to:
As for the free health care, patients have to bring their own medicine, their own bedsheets, and even their own iodine to the hospital. Most of these items are available only on the illegal black market, moreover, and must be paid for in hard currency—and sometimes they’re not available at all. Cuba has sent so many doctors abroad—especially to Venezuela, in exchange for oil—that the island is now facing a personnel shortage. “I don’t want to say there are no doctors left,” says an American man who married a Cuban woman and has been back dozens of times, “but the island is now almost empty."