I think there is a subtle difference ... but an important one ... in registering voters and fabricating what appears to be popular support by paying demonstrators.
The latter is a real insult to the concept of free speech, and to citizens who truly organize themselves at the grass roots level using their own personal time and funds to voice their opinions on public policy.
Regardless of who is paying demonstrators like this (right or left), it isn't right.
1973-1976 Lead policy analyst, health care, NYC Office of the Mayor (age 23-26, 25 staff)
1976-1977 Exec Director NYC Medicaid Task Force responsible for directing Medicaid across all City agencies (age 26-27, about 1000 staff)
1977-78 Assistant to the Mayor, Health care, responsible for coordinating all City agencies and authorities with respect to health care policy and operations (age 27-28, no staff)
1978-1980 (age 28-30, ~100 staff, overseeing 42,000 staff) Director, Management & Budget, NYC Health & Hospitals Corporation, overseeing budget reductions of 19% and layoffs of over 4000 staff in two years during which we went from every hospital having a provisional one year accreditation to no hospitals with any noted operational deficiencies in accreditation and certification audits and an increase in the volume of services provided.
For what it's worth, I left the public sector at that point, joining Arthur Young & Company (now Ernst & Young) where I became a Partner a few years later working almost exclusively with private sector clients.
While director for Medicaid, I replaced all payment systems then in use. The actual systems had been developed by the Rand Corporation a few years earlier at a cost of $20 million but could not be implemented because of problems in the eligibility systems that they were unable to resolve. I developed a conceptual approach for resolving those problems (called the "Dirty Goodwin System" in the initial feasibility studies) that allowed us to reconstruct and deploy the systems over a period of 12 weeks, immediately reducing expenditures by 8% as errors were eliminated (saving $200-300 million in the first fiscal year and more thereafter). When combined with changes in processing procedures that I developed and implemented, we were also able to reduce the time to process claims from six months to 10 days. This resulted in savings of about $50 million in financing costs.
Using the data from the new payment systems we were able to implement advanced fraud detection systems that allowed us to identify and target a class of providers that we labeled Medicaid Mills (the term had not been used previously). These were landlord organized clinics where rents were based on a percentage of all billings and the landlords offered physicians bonuses for referrals made to other physicians in the building. The landlords handled billings for the physicians and also acted as factoring agents, advancing them monies due from Medicaid. By eliminating payment lags we were able to break their hold on the physicians. By analyzing data from the new payments systems were were able to identify patient "ping ponging" between physicians at a common address to locate Medicaid Mills and structure surprise inspections/audits that resulted in numerous fraud investigations and convictions. The resulting savings from all of these programs totaled about half a billion over two years and were a major part of the City's strategy for emerging from bankruptcy at the time.
Jeff, as I recall, you mentioned leaving public service for a matter of principle, though I can't remember exactly what it was.
Too bad ... they could absolutely have used your talents with Medicare and in other states' Medicaid programs!
If you could generate these savings in 1980 through computerization innovation, I can only imagine what more of the same could do now for that simple drug usage database. I would imagine that health care insurors would welcome a way to decrease costs.
I am almost certain that many Medicare recipients are taken advantage of. I handled my mother's Medicare/insurance forms (she also had a supplement from the NYS employees' union). Many on Medicare would find this paperwork beyond them & never notice what was going on with the charges.
At no time in my life have I ever worked as hard as I did in government and at no time in my life did I ever feel that what I was doing was more important. It was truly a privilege and the things I learned were the foundation for the success I enjoyed in the private sector. Both were less important than raising my kids.
My mistake ... I thought you had also mentioned observing that political considerations impacted how people performed, or were allowed to perform, their jobs ... i.e. that the political aspect impeded getting the job done effectively & efficiently.Quote:
I left government primarily because I hit a point in my life where I had a wife in graduate school, a young child, and a mortgage and I needed my paycheck.
I wondered how they were going to balance the issue of crowd response with the Secret Service need to protect the President. Turns out it was easy....they simply stacked the deck.
Of course the WH claimed these were randomly selected. Right...a young lady and her mother from MA were randomly selected to attend an event in NH...and the mother just happens to be a huge contributor and supporter.