Filled Buckets Get Emptied

Column by Paul Hein.

Exclusive to STR 

In April 1953, the Department of Health, Education, and Welfare was created. Its first secretary was Oveta Culp Hobby. 

I’ve often wondered what Mrs. Hobby did during those first few days on the job. Did she bring her own insights and preferences to the agency? No, the agency didn’t exist prior to her appointment. Did she follow the path set by her predecessor? There was no predecessor. 

I suspect that during those first few days or weeks, Mrs. Hobby had an awful lot of meetings with her staff, and asked for many memos outlining the problems to be solved, and proposing solutions. This called for more meetings, to discuss the memos and assign full length reports. Why, in no time at all, the offices of HEW were buzzing with activity! Look for problems, and you’ll find them—especially if you’re paid to do it. 

Those opening days of HEW, or any government agency, perfectly exemplify the “law” expounded by the brilliant Dr. Parkinson: work expands to fill the time available. Pay someone to do something that had never been done before--probably because no one thought it worth doing--and in no time the job will call for additional workers, more office space, and, of course, a bigger budget. 

Ah, the budget! There might be a corollary to the professor’s dictum: work expands to utilize the funds available. Government provides many examples; but the one that currently comes to mind is medical care, or, as it should be called, medical financing. 

A television program recently featured the work of the Office of Inspector General in investigating and arresting those accused of Medicare fraud. It was surprising to see the OIG agents on the range, taking target practice with automatic weapons. One wouldn’t think that Medicare cheats are disposed to violence, but law enforcement seems to be increasingly militarized.  

At any rate, Medicare cheating is big business, and why not? The Medicare budget, we were told, is about $800 billion annually. With that much money available, “work” will expand to utilize those funds. Some of the “work” will be dishonest: billing for operations not performed, treatments not given, examinations not done. But most of the work will be honest, or at least legal: preventive medical care, especially check-ups, regular colonoscopies, PSA tests, MRIs, if there is any justification for them at all, and countless other medical procedures that a doctor might order to give his patient the best possible medical care, as well as minimizing the chances of a malpractice suit in the future. Yes, it’s expensive, but the government is paying for it, so why not pull out all the stops? Besides, doctor, all your colleagues are doing it, and your patients expect it. 

Decades ago, when Medicare first appeared on the horizon, I thought of it as a temptation: a juicy fruit available for the taking, just by providing extra medical services not strictly necessary. Would there be cheaters? Of course! To my way of thinking, that was just fine, as far as Medicare was concerned. The more doctors or hospitals Uncle could catch cheating, the greater the justification for more controls--and control is government’s middle name; just ask any doctor whose fees are set by bureaucrats. Plus there are the hordes of government workers employed just to detect, apprehend, and punish Medicare cheats, and the administrators, clerks, and assorted flunkies to supervise them. Perfect! What could be more desirable than ever-increasing numbers of people dependent upon the government for a paycheck, especially when they’re busy fighting for justice! It could hardly get any better! It’s the economic fallacy of the broken window, with pane replaced by pain, so to speak. All that Medicare cheating provides so many jobs! 

Government is the only organization that first gets the money, and then figures out what to do with it. And, by golly, they can always think of something--unless, of course, it’s returning it to its rightful owners. Spending expands to fill the budget available—and then some.


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