John Livingston

Adjusting for the Failures of Management

There is much to learn about our world when we examine different businesses and how basic economic principles apply to situations outside of the world of politics. Any person who has planned for a family budget, or run a business or a farm or ranch, understands that future unintended consequences and opportunity costs need to be accounted for and the operations that survive are the ones that can adjust quickly. We saw this play out dramatically, locally, and nationally during the government mandated close downs during the political Covid Political Pandemic. Adjust and move on—Chick Filet saw revenues increase dramatically as they adjusted their drive-in services to the point where sales increased as others like Wendy’s, Burger King and McDonald’s dropped.

Private and family run businesses were hit hard by the economic slowdown, but there were some that adjusted and thrived. In the medical world private individual practices that were being bought up by large providers prior to Covid, saw their access to patients dry up as networks became tighter and care priorities shifted. Private hospitals were able to adjust better than the large hospitals and physician run hospitals thrived as patient centric policies competed head-to-head with the subsidized large hospitals that had to cut down on basic surgical and medical services like cancer surveillance and elective surgery—that isn’t emergent, but many times is urgent.

Top down “command and control” policies were exposed for their inability to adjust during the pandemic. When patients receive their medical information from Federal agencies like the Centers for Disease Control (CDC) and National Institutes of Health (NIH) via the media instead of their family doctors, individual clinical decisions are replaced with a one size fits all model of care. Local Health Districts implementing directives from State agencies also contributed to policies that hurt Idaho children and families. Not allowing citizens the liberty to exercise their own judgement and tolerance for risk ultimately made the doctor patient relationship an unintended casualty of Covid government policy. Knowing now—and physicians, Physician Assistants( PAs) and Family Nurse Practitioners (FNPs), knew early on that 70% of casualties came from patients over the age of 70, and 70% of the rest of the casualties came from a patient population with at least two co-morbid conditions (obesity, diabetes, and or chronic lung disease being the three most common conditions), mitigation strategies should have been adjusted early on to protect the vulnerable and let the virus spread amongst the healthy and establish heard immunity naturally. The “Jab” at best offered short term and limited protection and may have impacted the “curve” and hospital admissions early. Mass population testing was appropriate early on but directing surveillance to vulnerable populations should have been the clinical priority after the first wave—adjusting for variants as need be. Lots of people made lots of money testing patients, but the information utilized from those tests was not maximized and may have ultimately confused the issue of who was sick from the virus, and who was sick with the virus.

So many questions during the pandemic were thrown around in public and were being answered by government bureaucrats who had little accountability or skin in the game. One of the most revealing actions by government agencies was to create legislation that would indemnify legislators and those in the executive branch from medical malpractice liability early on. There has not been such large scale “medical mal-practice” committed in our country in my lifetime as when State Agencies in New York ordered contagious patients back into nursing homes who were still able to infect vulnerable elderly patients living in those facilities. Where were the doctors who took an oath to stand up for their patients and who facilitated this process by writing transfer orders on those patients? Come to find out they too were indemnified by the NY legislature.

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If “emergency orders” remain in effect this universal indemnification continues. Where are the trial lawyers on this? But these orders also allow for payments for treating patients with a Covid diagnosis—no matter their clinical Covid Status. If the executive order remains in effect, if hospitals and providers continue to follow (CMS) protocols, accelerated income via transfer payments will continue—did you ever wonder why masks are still being worn in your doctor’s office and in hospitals?

Governments and political pundits have been making bad and costly predictions since the beginning of our Republic. Edwin Stanton President Lincoln’s Secretary of War said the Civil War would be over in one month with few casualties. President Bush predicted the Iraq War would cost $50 billion—it cost $1 trillion. We were told in Idaho that we would lose between 50,00-100,000 lives in the “pandemic”. We lost 5200 souls—one tenth the pandemic threshold until the UN changed the number several years ago. Had we reached the historical definition of a pandemic the predictions by experts would not have come true. What is never realized up front is that these are only predictions. Saying that they are grounded in “science” created an alibi and a false predicate. Computer models from the University of Washington aren’t “science”. Computer models for climate change aren’t “science”. In fact, COMPUTER SCIENCE isn’t science it is engineering. Any discipline that describes itself ending with the word science is probably not science. Eco-science (Rachel Carson of Silent Spring fame) had an undergraduate degree in journalism when she scared the world about DDT causing over 100 million deaths worldwide from Malaria and starvation. Journalism is certainly not a science. Social science, behavioral science and political science aren’t science. Chemistry and physics don’t use the word “science” after their names—they are truly science. When you see the name “science” after an academic name substitute “fake science”.

Instead of offering predictions, politicians and planners should talk in terms of probabilities and let citizens decide what is best for themselves and their families. Probabilities allow us to account for different outcomes. They prepare us to adjust based on future changing circumstances. Not only regarding medical care, but also various forms of welfare and education subsidies could consider various future probabilities and how future adjustments could facilitate better long-term outcomes. And besides the people making decisions about how to use resources would have actual skin in the game—not like politicians sitting in DC or Boise who don’t even know their names or the names of their children. Individual citizens making decisions based on risk and price will make less costly, more efficient, and more efficacious decisions.

Using round numbers think about an Idaho mother of three. It costs $10,000/ yr. to educate her children. She has a claim on future dollars of almost $420,000. Set up an account (allow for future access to funds based on performance in the classroom) and let her use the money to educate her children in a public school, a charter school, or a religious school—or a home school. Maybe a different school for each child because each child is different. A one size fitting one school choice for all children is like Covid policy. It is inefficient and value is lost. Let the various schools compete. The only people who would be against this are the teacher’s unions and those legislators who receive campaign funding from the teachers’ unions. People will make good and bad decisions. But the point is they will be able to ADJUST—quickly. Governments never are in such a position.

As government largesse grows and as the bureaucratic regulatory State becomes more ubiquitous, the ability to make timely good decisions will be lessened. The cost of government and to citizens(taxes) will grow. The size of government will grow. The accountability of government will lesson. There will be a regression to the mean just like we are seeing in health care. No excellence—just average. When was the last time that education test scores and health care outcomes actually improved? Maybe that is what progressive Democrats and Republicans actually want? If equity and equality and not excellence are the goal, then the “mean” will be lowered and the “regression” by everyone above and below the new mean will be faster.

Maybe it is time to “ADJUST”

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