I think it’s instructional when considering the government intervention on our health care system to consider how well they’ve done in other interventions. It would be especially interesting to just look at how the federal government has done in managing AIG or General Motors/Chrysler but I’ll leave that for another day because I can’t get one example out of my mind.
Many of you know I fly a lot. I won’t make it this year because of the economic downturn, but I’ve been a Platinum flyer on Continental when I lived in Cleveland and Delta now that I’m in Atlanta for most of the last 10 years. As such, I’ve had the chance to appreciate airport security both before and after the switch to government airport security following 9/11. I’m not impressed.
Prior to the government takeover of airport screening companies competed on merit to do the job. The argument that airports just bid it out to the lowest bidder says more about how silly government procurement rules are than the actual screening system. Companies knew they were pulling from basically the same labor force so the value they tried to add was with management teams that were expert or offered better service. For example, one firm hired a gentleman named Hovan Franko, an Israeli who was an expert in identifying non-verbal clues that someone could be up to no good. He trained not only his screeners, but airline counter people and others in the airport. It was a great and innovative service promoted by the free market.
Fast forward to today. While the government said the Transportation Security Administration was necessary to ensure consistent screening practices across the country and raise the quality of screening generally that simply hasn’t happened. I’ve lost count of how many airports I have traveled through since the TSA took over (well over 30) and I can attest to the fact that there is no consistency across them. Even when they eventually adopt the same rule, it might happen months apart. (For the record, the TSA people in Salt Lake City are by far the worst I have ever dealt with.) Most airports say nothing about a hair cream I have in my travel bag but never use. San Francisco told me it had to be inside my 1 quart plastic bag. The screeners at Canton/Akron actually argued with me that it was a liquid or gel and I had to explain third grade science to them. I’ve gone through security with a belt on several hundred times but this morning the machine went off and I had to remove it (same exact belt I went through security with three times in the last three weeks). Some make you remove a sweatshirt and others done. Some take 30 seconds to scrutinize your ID and boarding pass (as if they really knew what they were looking at) and some don’t care. To this date, none has told me the 1 once size Purell I have in my computer bag would have to go in my 1 quart plastic bag.
Some say, sure they’re inconsistent but the quality of screening has gone up. Well they would be wrong as well. Just about every audit of TSA performance done shows they perform at the same level and in some cases worse than the private security people did. Nobody should be surprised since in many cases it’s the same exact people doing the job. How about their management? Are there any Hovan Franko’s at the TSA? Not really. The best example is the whole 1 quart plastic bag fiasco. They implemented the rule five years after taking over because the threat of liquid explosives was so great. Think about this for a minute. Liquid explosives have been around for more than a century and they’re just now seeing that it’s a threat? Either they let us fly in great peril for five years or the whole thing is made up to boost their control over us.
Why is this a good case study for healthcare? There are a lot of reasons but I will outline a few.
1) They will be slow to react to new trends. Just like it took them five years to determine that a decades old threat was applicable to airport security, the government run health system will be slow to respond to health trends. They have no motive to do anything proactively.
2) People will generally sink to the level the lowest performers around them. Government employment generally is not where high performers go. There are lots of great reasons to work for the government and great government workers, but really ambitious people don’t go there. As the good people see weak performers linger on without any consequence they will get weaker just as has happened at the TSA.
3) The power will go to their heads. Ask anyone who travels today whether TSA people have let the power go to their heads. Their arrogance is amazing and the notion of customer service is completely absent from most of them. This will show up in call hold times, bureaucratic responses and stonewalling on answers. (of course I could use just about any government agency to make this point, not just the TSA).
4) They will lower standards to hire people willing to do the job. Remember the “high” standards originally proposed to be a part of the critical TSA? They wanted people to be citizens with a high school diploma. While both were used as criticisms of the privately run screening system, both requirements were eventually dropped for the TSA.
5) Rather than see costs come down, costs will go up as the inability to use private resources creatively forces more staff to be hired to meet gaps in coverage and skills.
I could go on but I won’t. Just think about every government office you’ve ever visited. Are the people who work there self starters? Are they driven by customer service? Are they quality minded? I’m not asking are there some people there who are these things but would you describe the whole office that way? I cannot think of a single place where I would.