Enough Inefficiency to Go Around

by Dick Hall-Sizemore

Folks here on BR seem to take great pleasure in pointing out and criticizing the shortcomings and inefficiencies of government. I have spent my entire professional career working in state government and I have suffered through more than my share of meetings at which nothing was decided and have seen a lot of inefficiency and some incompetence (though not nearly as much incompetence as some would have us believe exists). So, I can understand these complaints and agree with a lot of them.

However, what has always irritated me is the assumption, both implicit and explicit, that the private sector is always better. Somehow, the private sector is sacrosanct and, thus, is immune from criticism.

A recent experience provides me a two-fer — an opportunity to point out shortcomings not only in the private sector, but, as a bonus, in private medical services, as well. After consulting with an orthopedist, I decided to have a metal plate, implanted in my wrist many years ago, removed because it was causing some problems. It was a relatively simple outpatient procedure.

Remembering stories of patients getting surprise bills from anesthesiologists who were not employees of their hospital and were not included in the their insurance network, I called the hospital to inquire whether the anesthesiologist who would be putting me under was covered by my insurance policy. After being shunted among several offices, the answer was: they had no idea.

I was astounded. Here was a major component of the cost of my surgery and the hospital could not tell me whether I would personally be on the hook for it! I had known better to ask how much it would cost, but I expected them to at least be able to tell me if my insurance policy would pick up most of the cost.

The best they could do was give me the name of the anesthesiology contractor. I looked it up on the Internet and learned that it claims to be the largest anesthesiology contractor in the country. Before I called that company, I called Anthem, my Medicare supplemental insurance provider. The lady there told that, if the doctor participated in Medicare, my policy would cover whatever was not paid by Medicare. The website of the anesthesiology contractor said it participated in Medicare. So, after considerable time spent trying to find the answer to an obvious, simple question, I had my answer.

The next imbroglio occurred the day before surgery was scheduled. Someone from the hospital called me late in the afternoon to tell me that my surgery was scheduled for 11:00 the next morning and I should be there four hours, rather than the normal two hours, before the scheduled time. When I asked why so much earlier, the lady said that they had to conduct some pre-op tests, such as blood work and an EKG. I informed her that I had, as instructed, had those tests done the previous week by my personal physician who sent the results to the orthopedist, who in turn was to forward them to the hospital. She politely said that may be so, but the hospital had no record of those tests. She then said that, if I brought in the test results, I would not have to come in that much earlier.

I first indignantly informed her that I did not have the test results; that was handled by the doctors. Then I remembered that I might have access to the test results on-line. In the end, we settled on my getting to the hospital 2 ½ hours ahead of the time scheduled for the surgery.

I them called my orthopedist’s office and complained. My doctor’s assistant said she did not understand why the hospital folks said they did not have the test results because she had faxed them over. However, she would send them over again. In the meantime, she assured me that my doctor would have copies of the test results.

In the course of these conversations, I learned that the hospital had been using an outdated phone number for me that was in their system, rather my current number that the orthopedist’s office supposedly had sent to the hospital. That was why it took so long for the hospital to reach me that afternoon.

I was able to access the blood test results online, but not the EKG. I took the results in the day of surgery. The nurse processing me in was glad to get them. She said that the test results had come in overnight, but the fax copy was blurry and hard to read. That gave me a lot of confidence!

The surgery itself went well and my wrist and hand seem to be healing well.

The crux of the problem was a failure to communicate, although I cannot be sure where the breakdown occurred. Everyone has electronic health records, but each entity has its own system, and the systems do not talk to each other. My personal physician is in the Bon Secours system; the hospital is an HCA facility; and the orthopedist is with OrthoVirginia, which is not affiliated with a hospital system.

There was a simple way for me to have avoided this confusion  made sure my personal physician, any specialists I see, and the hospital I use all are in the same system. Of course, that is exactly what they want me to do.

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32 responses to “Enough Inefficiency to Go Around”

  1. LarrytheG Avatar

    I feel your pain. I have had the same issues and actually are in the throes of them as we speak.

    Here we are in the 21st century with internet – and doctors “communicate” by fax.


  2. vicnicholls Avatar

    “Somehow, the private sector is sacrosanct and, thus, is immune from criticism.”

    Oh no Dick, I can tell you the health sector is loaded with the same bureaucratic bungling and mismanagement and foolishness as any other. That is just one of them, but no, they’re not immune.

  3. Dick I’m glad to hear that your wrist is doing better. It’s a good thing you didn’t blow a gasket while dealing with all the red tape!

    I doubt you’ll find a single conservative contributor to this blog who would argue that the private sector is always more efficient. All bureaucratic organizations, whether government or corporate, tend towards inefficiency. The question is whether or not incentives and governance systems are in place to counteract the inevitable bureaucratic sloth and lethargy.

    There are plenty of big bureaucratic corporations… but they don’t last long. They go out of business or someone takes them over and shakes them up. Governments never go out of business. And it’s rare that they get shaken up. (The Goochland Revolution might be an example of a rare instance in which a local government did get shaken up.)

    Among the worst private-sector offenders are monopolies and companies that use the power of government to thwart competition. The health care industry is probably the very worst offender in the U.S. Private-sector inefficiency is rampant. The critical question to ask is why. Is that inefficiency due to some inherent property of the market economy? Or is it due to the way government has shaped the industry to thwart competition and accountability?

    The only consolation is that there is so much inefficiency that we could drive down health care costs for years to come if we could only figure out how to reward the right kind of competition.

    1. vicnicholls Avatar

      Add internet monopolies like Cox …

    2. LarrytheG Avatar

      It’s true, the private sector has competition to chase inefficiency but I’d point out a couple of things.

      1. – Medicare is said to be exceedingly efficient in terms of administrative costs compared to the private sector:


      2. – Government run health care in other countries is much more efficient than ours, costs are 1/2 or so and despite claims of horrendous wait times and people dying of cancer, etc… all those other countries actually have longer life expectancies than us.

    3. Eric the half a troll Avatar
      Eric the half a troll

      “There are plenty of big bureaucratic corporations… but they don’t last long.”

      Clearly someone who has never worked for big oil…

      1. LarrytheG Avatar

        Conservative Fairy Tales are like pimples… No matter what you do ………..

        One of the significant difference between Govt and the private sector is transparency.

        We’ll never know most of Walmart or GM or Verizons screw ups… and we surely don’t know all of govt, but we do know a fair amount comparatively.

        Then when we actually do have comparisons – like with our schools and SOLs and really a plethora of data , Conservative types used that transparency to argue that private sector schools will do better but almost never have I seen the same Conservatives argue for equivalent transparency.

        1. Eric the half a troll Avatar
          Eric the half a troll

          Sometimes you need a big bureaucracy to do big things. There is a reason why big oil operates in the harshest and most remote environments and small oil hangs out in Texas. You will note that Shell is a big player in offshore wind in the Northeast. Yes, insurance companies are big bureaucracies but look at what they have to do. Same thing for government – they have the biggest job of all. Private corporations are just not up to the task – it is not what they do.

          1. LarrytheG Avatar

            Looking at one of the biggest GOvt bureaucracies – the US Military and their airlift… good, bad and ugly for sure but surely one of the few organizations in the world that could carry it out.

            And yeah, they left a shit-load of equipment there already ..

            That airport – needs, electricity, water and sewer… and definitely sewer with 10,000 people pooping ever day…

          2. Eric the half a troll Avatar
            Eric the half a troll

            Yes noticed today they are up to 53,000 people airlifted. Quite impressive and our military is the only organization that could do it.

          3. LarrytheG Avatar

            BUT – how EFFICIENT are they REALLY?

            All we have is their word and a successful-looking operation, eh? They could be burning dollars left and right!

            I’m betting they still have $600 toilets on those planes… AND that they are likely full of you know what…

  4. Publius Avatar

    I am glad you got through everything. But I would not exactly call our health system private sector. It is so screwed up with government entanglements. What is the “real” price of anything? If Anthem, A; if United, B; if Aetna, C, if Medicare, 0.85 A b or C; if no insurance, 2A,3B or 4C. If an illegal, FREE!
    Have you noticed how all the non-insurance elective things have competitive pricing? It’s neither fish nor fowl right now…
    But I am with you on working your way through…absolutely frustrating, and often you get info that is not quite right…oops!

    1. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      Anthem, United, Aetna, etc. are not “government.” They are private companies.

      1. Publius Avatar

        No…but you have the intersection of employer provided plans, ERISA, Medicare, etc. The large employers are essentially all self-insured and the insurance companies are regulated at the State level, acting as re-insurers there, while the employer has to comply with federal and then many State specific laws. The InsCos are not all that different from public utilities at this point. Sort of like the tobacco companies…the States are so hooked on tobacco money…

  5. Super Brain Avatar
    Super Brain

    Even using a doc in the same health system is no assurance these days. Sometimes the insurance co fights that.

  6. DJRippert Avatar

    Interestingly I was about to write an article about the Boston Properties’ mismanagement of the Reston Town Center.

    For years parking was free. I worked in the Town Center for 12 years and marveled at the mixed use, walkable features.

    A few years ago Boston Properties (who I understand owns most of the Reston Town Center) implemented this clumsy and inefficient paid parking system which required a special smartphone app, recording of your parking place, paying to park although you are going there to spend money, etc.

    One would have though that COVID might have changed things in the commercial real estate business.

    I went there at 11:30 am last Wednesday. It was a ghost town. The garages were empty. But you still have to pay to park in an empty garage.

    Then I went out into the Town Center to shop. I was amazed by the number of closed stores. A once popular Asian restaurant (Big Bowl) is completely boarded up. The best Thai place in NoVa (Busara) is long gone.

    I checked the internet. Paid parking killed Busara in Reston. That was in 2018. Then came COVID. Then came the commercial real estate meltdown. Then came the pressure on restaurants.

    But you still have to pay to park in an empty garage.


  7. Nancy Naive Avatar
    Nancy Naive

    Stone knives and bear skins, Dick. We’ve come along way.

  8. Nancy Naive Avatar
    Nancy Naive

    The private sector is just as inefficient, plus is more expensive (profit must be had, don’t ya know), AND with a higher level of redundancy (get three bids).

  9. FluxAmbassador Avatar

    Any sufficiently large organization is going to suffer from inefficiencies. It’s easy to pick on the government’s because government is the largest organization there is and because it is beholden to a level of transparency that has analog in the private sector.

    The older I get the most absurd our entire method of delivering health care appears. It’s expensive, opaque, confusing, and time intensive.

  10. Steve Gillispie Avatar
    Steve Gillispie

    So now you can read minds. As a sometimes critic of government, I take no pleasure in discovering or commenting on its failures.

    Are you really so uninformed that you do not know most conservatives and anyone else favor the government doing what it is supposed to do – assure that all have equal opportunity not equal outcomes, maintain a level playing field and prevent the criminality which is inevitable wherever there is money to be made? People with common sense are not in favor of government leaning on the scales to create some social outcome bureaucrats and politicians think best for us.

    Do you not know that the health industry is a government creation where regulation has created the most non-competitive sector in our country, prevents new competition with idiotic CON requirements, crushes doctors with paperwork and bureaucracy, is permitting hospitals to further monopolize the industry by purchasing medical practices, and actively suppresses competition by outlawing cross-state competition for insurance companies — to name just a few of the ways in which elected officials and regulators, both clueless and bought, have made health care much more costly and increasingly more inefficient.

    1. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      There are few inherent functions that governments are “supposed to do”. Protecting the nation from foreign invaders and providing internal security for its citizens are the two that spring most readily to mind. For most of the functions beyond that, the government is “supposed to do” what “we the people” decide we want it to do.

    2. LarrytheG Avatar

      I keep looking for the countries that do health care like folks like Gillispie advocate.

  11. Matt Hurt Avatar
    Matt Hurt

    Unfortunately, we know a lot about medical systems, as my wife was diagnosed with a very serious, life altering condition in 2013, and has been treated for that, as well as treated for the complications of the treatments since then. Here’s what I have learned about our health care system. Since most patients are not the ones who write the checks (at least the biggest part of the bill) to the doctors, hospitals, etc., there’s really no incentive for the providers to address our concerns on such matters. They really are beholden to the insurance companies, since they do write the checks. If a patient gets upset, so what? There’s plenty more folks who will take their appointment slots.

    I really think that we have conflated healthcare with health insurance in this country. I understand that this happened during WWII, when the government instituted price controls on labor. Since there was a shortage of labor, and companies could not offer increased wages to entice workers, they offered benefits such as health insurance. From that time on, health insurance was primarily tied to employment, which brings on other problems.

    One of the biggest problems with health insurance is that is has strayed from the original intention of being a hedge against catastrophic health costs, and has gotten into the more routine health costs, such as yearly checkups, regular medications, and etc. This has further distanced the providers from market forces since the consumers (patients) don’t deal so much with the actual costs. Therefore, providers tend to charge more that what they would if the patient was paying. Don’t believe me? Check out what the cost of medical care with and without insurance.

    So, in my opinion, government interference in the labor market back in WWII had long lasting impacts which negatively affect us to this day- some 80 years later. Of course, that interference was viewed as necessary because of the emergency of WWII, not unlike the emergency of 9/11 (the Patriot Act), and Covid (destroying our economy with lockdowns and paying folks more to produce nothing other than a butt divot in the couch). Hopefully, one of these days, we will become wise enough as a country not to let our betters in government use emergencies to foist their well intentioned policies upon us which very often have very detrimental unintended consequences.

    1. Matt Adams Avatar
      Matt Adams

      Similarly seen in the price of College that has ever increased as the Government backed loans. Which is why you’ve got a Physician who gets a 4 year pre-med degree ($120k) and immediately spends another ($200k) on Medical School.

    2. LarrytheG Avatar

      Hey Matt. Always good to hear your reasonable views!

      The simple reality is that we COULD CHOOSE to self-insure – to simply be responsible for our own health care.

      But when we buy insurance, we do cede to them, what affects THEIR interests over ours – your point.

      Also, Government “interfere” with Medical Underwriting which means the insurance companies cannot refuse to insure you if you are too big a risk for them which is what a life insurance or home insurance company CAN DO.

      Are we prepared to let health insurance companies decide who they will cover or not and let those they refuse to cover make other arrangements?

      My point? You can’t have it both ways.

      choose one – and understand the consequences.

  12. tmtfairfax Avatar

    Lots of inefficiency in the private sector, but competition, if extant, tends to drive out inefficiencies or put the inefficient company out of business. There is no such pressure on government, and less pressure on private businesses that are funded by government or a captive customer base (e.g., Dominion Energy).

    As I’ve posted before, years ago I attended a conference on regulation. One of the other attendees was a former Labour Party member of Parliament. He spoke about the fact that, by and large, competition in the private sector had generally shifted market power from producers to consumers but not in situations involving the government or de jure monopolies. It was one of those paradigm-shifting moments. Ever since talking with that gentleman I looked at things differently.

  13. The surgery itself went well and my wrist and hand seem to be healing well.

    That’s the most important thing. I am glad it worked out for you.

  14. Steve Gillispie Avatar
    Steve Gillispie

    There are 3 basic components of healthcare cost:(1) Hospitals, (2)Drug Companies, and (3) Insurance companies. Unfortunately the public sees only the insurance companies; but they are only the Sharksuckers at the party and not the cost drivers.

    Force competition into the hospital world with the same consumer and anti-trust protections demanded of other businesses; force national competition with larger risk pools on the insurance companies; and prevent drug companies from writing off their worldwide market-share expansion costs on the US public and we would see dramatic cost reductions and increased efficiencies.

    The big-company controlled Democrats will not permit the first two and this globalist-controlled administration immediately rescinded the MFN mandate as it has done with everything else the previous administration did which addressed “main street” problems.

  15. Ronnie Chappell Avatar
    Ronnie Chappell

    Given that hospitals in most communities have no competition and rely on third parties and not health care consumers for compensation most are less concerned about inefficiency, cost and consumer experience than, say, the average fast food restaurant, Walmart or Amazon which see the elimination of inefficiency and customer satisfaction as key to increasing revenue and net income.

    1. Steve Gillispie Avatar
      Steve Gillispie

      True. But in many cases they have no competition because of now-idiotic CON requirements. And even if remote, they would respond to market forces. The ever-growing increase in “medical tourism” demonstrates that clearly.

  16. LarrytheG Avatar

    The number one way to have true competition in health care is to allow the insurance companies to use traditional actuarial underwriting standards like they do for other types of insurance.

    Let the insurance companies set premiums based on the risk level of each subscriber just like we do for life insurance, auto insurance and homeowner insurance.

    If you truly want a free market – put your money where your proverbial mouth is. Otherwise, admit, you do favor the govt telling insurance companies who to insure and for how much.

  17. Merchantseamen Avatar

    Gubermint is arguing and wasting (inefficient) time becasue it is not their money. Private has a profit to worry about. Time is money. However yes they are not above reproach in some of their practices.

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