Washington Waste – dumb uses of taxpayer money

Sen. Tom Coburn (R-Ok.) has again issued his annual “Wastebook”  containing 100 of the dumbest uses of taxpayers’ money:

  • the National Endowment for the Humanities devoted almost $1 million to the Popular Romance Project to “explore the fascinating, often contradictory origins and influences of popular romance as told in novels, films, comics, advice books, songs, and internet fan fiction, taking a global perspective—while looking back across time as far as the ancient Greeks.”
  • The National Science Foundation spent a quarter of a million dollars to study “attitudes toward the Senate filibuster among the American public.”
  • The Army spent nearly $300 million on a blimp for surveillance in Afghanistan—only to drop the project after its inaugural U.S. flight, selling the airship back to its maker for $301,000.
  • The International Trade Association devoted nearly $300,000 to send Indi Rock music executives on a tour to Brazil.
  • The National Institutes for Health dropped $335,525 on a study which determined that “marriages that were the happiest were the ones in which the wives were able to calm down quickly during marital conflict.”
  • The $1.9 million Senate Office of Education and Training provides classes for staffers on such subjects as sleeping well and making small talk.
  • The National Endowment for the Arts used $10,000 to underwrite the PowerUP Project, which featured choreographed (utility) pole dancing.
  • Housing and Urban Development used $1.2 million to create an apartment designed for the deaf in Tempe, Arizona, only to then decide that three-quarters of the residences should be occupied by people with normal hearing.
  • The Agriculture Department gave an Oklahoma winery $200,000 to purchase new equipment.
  • The Institute of Museum and Library Services gave a New York museum $150,000 to create an exhibit on play.
  • NSF spent $2.9 million to create sites “where arts and science will be used to educate the public about Indianapolis’s water system.”
  • The Commerce Department provided Las Vegas with $800,000 to think about economic development.
  • The U.S. Marshals Service dropped nearly $800,000 on promotional “swag,” including Christmas ornaments.
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Is this where food stamps should go?

A woman called to check her food stamp balance. It was about $400 because she didn’t know she was still getting benefits. She tweeted that she “might let them build up and sell them.” After all, she has a cable bill of $140 to pay.

She has an iPhone (how much does that cost per month?), WiFi, and “needs to smoke me a joint” so she is going to call her “weed man.”

Her air conditioner is cranked up high “It’s soooo cold in my house. Everybody keep telling me to turn the AC off.”

She has money to spend at Hooters, IHOP, and TGIF Fridays. “I needed to take myself out. I had a rough week.” She is going to buy a new iPad for her mother.

All this we know via her Tweets. What more don’t we know about this food stamp recipient?

Should these bureaucrats be shut down permanently?

Bureaucrats at the Federal Mediation and Conciliation Service average $120,000 in pay and here are some of the things they buy for themselves with their federal purchase cards:

  • leased a $53,000 car for private use
  • rented a storage locker near a top officer’s home – filled with the employee’s personal goods
  • ditto, a storage area for a second employee’s goods. Nobody at the agency had keys for either storage area.
  • $58,000 to what appears to be a sham company set up by one of the top officers, and which did absolutely nothing
  • hundreds of dollars every month for phone, internet, and cell service for one employee at his home office, his second home, and for his wife

The FMCS is one more example of Mitchell’s First Theorem, that government is a racket for the enrichment of bureaucrats.

Are the youth anti-government?

The Atlantic has an interesting article about the Millennial generation, the 95 million Americans born between 1982 and 2003. Here are some snippets:

  • They don’t see politics or government as a way to improve their communities, their country, or the world. So they are rejecting public service as a career path.
  • “Politics just doesn’t seem relative to a lot of us and our world. [T]ell me one big thing that has come out of Washington. Results are important to us, and sadly, politics isn’t a place for results.”
  • Millennials believe traditional politics and government (especially Washington) are the worst avenues to great things.
  • 51 percent of Millennials believe that when government runs something it is usually wasteful and inefficient, up from 31 percent in 2003 and 42 percent in 2009.
  • 86 percent of Millennials support private Social Security accounts and 74 percent would change Medicare so people can buy private insurance. Sixty-three percent believe free trade is a good thing. Only 38 percent of Millennials support affirmative action.

 

Eliminating the Middleman

Everything that is really great and inspiring is created by the individual who can labor in freedom. — Albert Einstein

Lower costs, improved outcomes, better consumer experience – isn’t that what we would all like in health care? That’s not just a dream – it is the actual result of a growing number of physicians you might label “Do-it-yourself Health Reformers”. They haven’t been waiting around for politicians to fix the broken health care payment system; they have been implementing new models for the practice of health care.

Improved outcomes? How about 91% of patients achieving their target blood pressure within 6 months? (Compared to a national average of less than 50% of patients.) How about being named one of only four Cardiovascular Centers of Excellence in the state?

These physicians focus on keeping patients healthy and out of the expensive parts of the health care system, such as specialist offices, emergency departments, and hospitals. ER visits are down 62%, specialist referrals are down 55%, advanced radiology down by 48% and surgeries down by 73%.

The net result of better primary care was a savings of 20% to 30% in overall health care costs. Customers of this new model of health care delivery provided their employees a better health benefit and also saved 20% compared to what they had been paying. How often do you hear about health care costs actually going down?

Or consider this case. A diabetic woman had been spending $5,000 per year on medical care. When she switched doctors, her new doctor reported that “When she arrived her HGBA1C was 11.9 – meaning very poorly controlled. One year later her A1C was 6.8 (well controlled) and she had only spent about $450 for an entire year of care with us – including the annual physical, all of her follow-up visits, all of her lab work and ancillaries.”

So how do these doctors deliver better health care at lower cost? The answer is surprisingly simple: They eliminate the middle man between doctor and patient, i.e. the insurance company or government (Medicaid or Medicare). Removing the bureaucracy from the mix cuts 40% of fat out of the process. Not just money, it saves paperwork and frustration, leaving more time for the doctor and patient.

A traditional primary care practice has a large staff just to deal with the paperwork. The national average is 3.9 non-medical staff members per doctor or nurse. A typical Direct Primary Care (DPC) practice has just one staff member for two doctors. Some have zero staff. This reduction in overhead allows a DPC physician to charge much lower fees yet still spend more time with each patient.

Many DPC practices provide lab services in-house, further reducing costs and providing better service to their patients. Most negotiate with lab companies. The lab companies offer huge discounts for avoiding the time and hassle of billing insurance companies or the government. One DPC physician reported that he could get a cholesterol test for $3 versus the $90 the lab would have billed an insurance company. An MRI was $400 compared to a typical rate of $2,000.

In addition to primary care, most DPC offices also provide urgent care such as stitches or casts, handling many of the same problems as an emergency room. They provide treatment for about 80% of health care needs.

Most DPC providers operate on a mixture of monthly membership fee, typically $75 per month, and per visit charges. Members receive an annual exam, a discount on fees, and access by phone or email. About a third of the patients are uninsured, some because they cannot afford insurance premiums, others due to preexisting conditions such as diabetes. Ironically, uninsured patients at a DPC practice receive better service than insured patients at a traditional practice.

Insurance is a terribly inefficient way to pay for most health care. Primary care, even including occasional urgent care, is relatively affordable – much more affordable than the insurance premiums. It is more economical to pay the doctor and nurse, than it is to pay the doctor and nurse, and pay their non-medical staff to process paperwork, also pay the insurance company staff to process paperwork, and also pay the insurance company profits.

The most sensible way to pay for health care is with a high-deductible catastrophic policy that we hope we never need to use, put the huge savings in premium cost into a Health Savings Account (HSA), then pay a DPC physician via a debit card from the HSA. There is much, much less overhead, the DPC practice spends more time keeping patients healthy, resulting in lower costs for specialists, surgery, or hospital care.

What doctors enjoy is interacting with patients, solving problems, helping their patients stay healthy. What they hate is paperwork, overhead, and a bureaucracy pushing them to spend less time with patients. They are so frustrated by middleman-governed health care that 9 out of 10 are unwilling to recommend health care as a profession.

DPC eliminates the paperwork, overhead and bureaucracy, leaving doctors happily working to improve their patients’ health. These doctors say “I am finally back to practicing medicine the way I was trained.” And that is the major reason that surveys show that 16% of primary care physicians plan to move to DPC or other retainer-based practice.

14,000 wind turbines abandoned and slowly decaying

Built only for the tax credits, abandoned when the tax credits run out, why is nobody clamoring to have the mess cleaned up?

In most instances the turbines are just left as symbols of a dying Climate Religion. Nowhere have the Green Environmentalists appeared to clear up their mess or even complain about the abandoned wind farms.

More energy – mostly from fossil fuels – was consumed building these windmills then they ever produced.

Alameda County, California, reported that one wind turbine project alone killed 10,000 birds, including hundreds of eagles, owls, hawks, and falcons.

The Road to Hell is paved with good intentions.