Abolish FEMA? Here's a Few Other Suggestions

So a Senate panel has recommended abolishing FEMA. Of course, they want to replace it with a new but similar agency. The Federal government is incredibly good at making sure the last disaster won't happen again (e.g., September 11 (no one will ever hijack a jetliner in that way again; they'll have to figure out another attack mode), the Challenger explosion, the Columbia incineration, and now Katrina. But if they replace it with another agency that works more or less the same way, all they will achieve is rearranging the deck chairs. A more appropriate idea would be to separate disaster response into its two basic aspects: emergency response (including search and rescue and fundamental life support, which would best be done by the military -- as they are the only agency of government that has the equipment and manpower to do the job) and reconstruction (which probably could be planned for in advance by a FEMA-like bureaucracy). This idea will, unfortunately, never dawn on the bureaucrats who can only think of ways to perpetuate their fiefdoms.

While we are thinking about abolishing Federal agencies that don't work, I have a few other suggestions of agencies that need to be abolished and replaced with ones that work better. Well, okay, some of these aren't necessarily complete agencies, but you get the idea.

Medicare Part D -- If you've been reading my blog, you would know this would be on the list. It may look like it's working well, but so did FEMA in 2004. This boondoggle will eventually become a nightmarish drain on the economy, as it simultaneously stifles medication research and blocks the use of what few newer and better drugs that come along (due to the eventual focus on reducing costs at the expense of everything else). Medicare Part D delenda est!

Medicare -- Not a big stretch here. Administrative costs are higher than those in charge will ever admit, and the bigger organization has for years been focused only on reducing the outlay of dollars while simultaneously being pushed politically to expand coverage to more services at more cost. Thus the only solution the bureaucrats can come up with is to pay physicians, hospitals, etc., less and less while requiring more and more. (More about quality performance standards and "pay for performance" in a later post.) The situation is untenable and is guaranteed to collapse within the next couple of decades, if not before.

Medicare Physician Payment Rules -- If we can't get rid of the entirety of Medicare, then let's at least abolish this and come up with something that makes sense. Currently Medicare Physician Payment annual updates are based upon an immense number of factors, including the number of services provided globally (the so-called volume performance standards, which make payments go down as the number of services provided go up, while the performance standards being adopted require the provision of additional services) and a measure of the performance of the economy as a whole (linked somehow to GDP, as if this had anything to do with the cost of providing medical care). If emergency one-year fixes ever cease, and the projected cuts in physician reimbursement ever go into effect, physician payments from Medicare will decrease something on the order of 35% over the next 6-7 years. And many private insurance payments are linked to Medicare rates. No other business could survive a 35% decrease in revenues while costs (employees, supplies, insurance) continue to climb without driving straight into bankruptcy, so why should anyone expect doctor's offices and hospitals to be any different? And once doctors and hospitals close shop and go off and do something else, where are the patients going to get their care?

The VA Medical System -- The only people who think this works are the people running it. Personally I think our veterans would be better served with an insurance card that worked like a new and improved Medicare and which could be used at any participating doctor's office or hospital. I have seen the VA schedule a colonoscopy for a patient with blood in his stools for six months in the future; fortunately, this person had other options and had the colonoscopy before the colon polyps had a chance to turn into colon cancer. If I had done that it would have been considered (appropriately) grounds for a malpractice suit. Virtually everyone that works in medicine and has had experience with the VA system, and well as the veterans sentenced to receive their care through that system, has or has heard of a horror story related to the VA medical system. This one just needs to go. Don't bother to replace it. Our veterans deserve better.

The Food and Drug Administration -- This agency does a lot of good. Two things would make it better. The drug approval process needs to be fixed to get new medicines on the market quicker (yes, I said quicker); this however would probably require a restructuring of the entire agency (to get rid of the bloat and deadwood). The agency also needs to have the authority to regulate herbal medications. For those who would argue that herbal products are natural and thus shouldn't be regulated, I can only say that arsenic, cyanide, aflatoxin and ricin are also natural products, so maybe they shouldn't be regulated either.

Managed Care -- I don't know where to begin. This will be covered in more detail in another post.

I welcome other suggestions -- but only those having to do in some way with medical care or health. This is medical ranting, after all. I could come up with a much bigger list than this if I included non-medical agencies.