So, You Want A Bureaucracy To Manage Your Healthcare

Why don't bureaucracies produce the expected results?  We've all heard of and experienced the gross incompetence of public and private sector bureaucracies.  Who hasn't been insulted and outraged by the bureaucracy you were required to deal with by some enterprise or government entity?  And when you add organized labor into the mix, it becomes even more frustrating, annoying and aggravating.  What is it about a bureaucracy that allows well-intentioned collaboration to become an unmanageable behemoth, consistently failing to deliver the expected results?

Let's begin with the individual.  Most of us, if not all of us, begin our journeys with hopes, dreams and aspirations.  However, it is truly the rare individual who converts those visions into a lifelong pursuit.  (In some cases, these rare persons unwittingly trap themselves in a bureaucracy, e.g., civilian and military pilots.)  The rest of us continue to fantasize while either conforming to societal expectations or simply allowing events and circumstances to determine our fate.  The difference between those that pursue and those that don't is the extent to which passion and determination fuels their energy and ambition, and keeps their focus on their pursuit.

Generally speaking, bureaucracies don't attract those with passion.  Bureaucracies attract those who seek safety, security, acceptance and approval, and who make career decisions based on immediate opportunities, personal needs, issues and desires; which pretty much describes the rest of us.  Consequently, the workforce of a bureaucracy is comprised of individuals who chose the default selection for a career.  It's not what they would do if they believed they had the power of self-determination.  Not exactly the kind of person essential to a culture of excellence.

Then, we put this person in a job that is routine, repetitive, and/or tedious.  The job offers little challenge after you’ve learned it, almost no fulfillment or satisfaction and does not encourage creativity or imagination.  This promotes increasing focus and attention on things unrelated to the task at hand but which provides a diversion from the daily drudgery .  Eventually, the thrill and anticipation of a new career are replaced by resignation, frustration, dissatisfaction and envy.  And for those grappling with serious personal issues, they become disgruntled and uncooperative employees putting increasing distance between themselves and those whom they serve.

For those with some semblance of ambition, and desire for recognition, achievement and advancement, a bureaucracy can be a pretty good place to fulfill those desires.  Bureaucracies need managers and administrators just like any other enterprise.  The question becomes, how to manage an ascending career without jeopordizing the benefits that brought them here in the first place.  The unintended consequence is management spends more time looking up the organization than looking down.  The rank and file soon realize management isn’t working for them and that they are being ignored.  Collective-bargaining is unintentionally invited into the organization and universally embraced even by those who never thought they would wear a “union” label.

All of this combines to create the ideal environment for a rigid and unchangeable structure.  Since creativity and imagination are not encouraged, and because job security is paramount, decision making introduces risk and invites complications.  Consequently, policies, procedures, standardization, rules and regulations become the order of the day, all in the name of efficiency.  Employees soon learn to serve the organization, and that serving the “greater good” affords much more safety and security than serving the individual.

The real issue lies in the expectations of those for whom the bureaucracy was intended to serve.  Simply put, the customer expects excellence without fault which, almost by definition, is impossible for the bureaucracy to deliver.  And while many private sector bureaucracies manage to overcome their inherent tendencies, there is not one example of a federal bureaucracy which has ever exceeded the taxpayers expectations in terms of efficiency, responsiveness and sincerety.

Three Issues with President George W. Bush

May 15, 2013

The Honorable George W. Bush

Office of George W. Bush

P. O. Box 259000

Dallas, TX  75225-9000

Dear Mr. President:

Thank you for your service to our nation and congratulations on the completion and dedication of your presidential library.  I look forward to my first opportunity to visit and tour this impressive historical facility.

Generally speaking, I believe your two-term administration was effective and the nation benefitted from your leadership, especially following the 911 terrorist attacks.  However, there were moments where I questioned your actions and decisions -- there are three specific occasions I wish to address.  I am hoping you will take the time to provide me with a more comprehensive rationalization for the courses you chose.  I have no right to ask for this nor do I believe you have to justify anything to me -- I chose to sit on the sidelines while you chose to get in the game -- I'm simply curious.

The war in Iraq went on far too long.  The "surge", in my mind, was more of an indictment on how the war had been prosecuted to that point.  I never got the sense from you or the Secretary of Defense that urgency was an essential element of your strategy.  (Urgency being the recognition that as long as you are fully-engaged in a major initiative, you cannot address other initiatives in a comprehensive fashion.)  I understand that nation-building is a slow, deliberate and arduous process; however, it just seemed that as long as there wasn't any real pressure to bring our troops home, other than Cindy Sheehan, you appeared content to sustain our prolonged involvement.  I'm not convinced it was ever about Iraqi freedom.  It was, more likely, another means of financially doping our national economy.  I believe the opportunity costs of this war will have as much influence on your legacy as any of your pro-active policies.

Illegal immigration is more than a human tragedy.  In my mind, it has the potential to destroy our nation as we know it.  Not because we don't have the ability or the desire to absorb another twelve million residents, but because it is now acceptable to disregard those laws which offend our

sensibilities, and it is acceptable for our elected officials to disregard their oaths of office.  The rule of law is the only thing that sets apart civilized societies from others.  I never believed you did your utmost to uphold the law of the land when it came to protecting our borders, or that you trusted the ingenuity, imagination, and creativity of the American spirit to solve the labor availability crisis.  I will never stop believing we could have found a way to satisfy our labor requirements without compromising the security and future of our nation.

I watched your library dedication television interview on Fox News.  Toward the end, you were asked about America's future role in foreign affairs.  I don't disagree with your position that we must not retreat from our historical prominence.  However, the success of nearly every human endeavor is a function of financial investment whether in the private, public, or non-profit sectors.  The prosperity of this nation once allowed us to heavily invest in those initiatives intended to make this a safer and better world for everyone.  We were once a generous nation driven more by virtue and ideology than by self-absorption and instant-gratification.  We once managed our finances responsibly which allowed us to lead and to respond immediately in time of crisis, and to challenge the bullies among us.  Sadly, this is not the case today.  Our growing demand for domestic entitlements, our grotesque national debt, and our continued disregard for balanced budgets, has literally stripped this nation of its teeth -- we have become a paper tiger.  How do you propose to be that worldwide force for good without the financial wherewithal to be the leader of the free world?

By now, you probably think I am woefully naive when it comes to matters of government and politics.  You may have concluded my altruistic tendencies have preempted my ability to grasp the nature of humans and the reality in which we exist.  But this I know -- aspirations are the energy of nobility.  If we are not aspiring for something greater than what we have become or have already achieved, then we are on the same course as every other failed society before us.

All the very best,

Bill Monroe