American Elephants

A Little Rousing Joy by The Elephant's Child
December 13, 2014, 9:47 pm
Filed under: Politics

David Hobson – Carols by Candlelight – The Holy City
Monday, 24th December 2012
Sidney Myer Music Bowl — Melbourne, Australia

Go ahead, enlarge this one to full screen.

And once again the scene was changed,
New earth there seemed to be.
I saw the Holy City
Beside the tideless sea.
The light of God was on its streets,
The gates were open wide,
And all who would might enter,
And no one was denied.
No need of moon or stars by night,
Or sun to shine by day;
It was the new Jerusalem
That would not pass away,
It was the new Jerusalem
That would not pass away.

Sometimes a Picture IS Worth a Thousand Words. by The Elephant's Child


The IRS Is Wasting Your Money in Improper Payments by The Elephant's Child

The Internal Revenue Service continues its outstanding record of honesty and competence. A new report from the Treasury Inspector General for Tax Administration has revealed that “nearly a quarter of the $63 billion worth of Earned Income Tax Credits distributed in 2012 were improper payments.”

In 2010, Congress passed a bill called the Improper Payments Elimination and Recovery Act of 2010. They convened a hearing to investigate the progress or lack thereof. Some of the agency witnesses tried to convince the committee that at least modest progress was being made, but the GOP members weren’t buying it. They were looking at five years of over $100 billion in improper payments. This was at a hearing in July, 2014.

“Excuse me for getting a little bit intense about this,” said Republican Congressman John Mica, waiving a piece of paper in the air.“They are astounding figures,” said Mica. “You could balance the federal budget just by correcting some of these very significant amounts of money that are going out the door unchecked.”

Improper payments include overpayments to people or vendors, spending without sufficient documentation, or simply, checks sent to the wrong people (or even dead people). According to the GAO, the five programs with the highest dollar amounts accounted for nearly 90 percent of the payments. And Fiscal Year 2013 isn’t an anomaly. “It’s been over $100 billion for the last five years in a row,” said Mica.
The Earned Income Tax Credit (EITC) has routinely been flagged as a high-risk area with lax oversight that will probably put billions of tax dollars in the wrong hands. Amounts are likely to rise because of  President Obama’s executive order on Immigration. Up to 5 million people might qualify.
The problem with Big Government is not simply bigness, it’s the layering on of bureaucracy. A law is passed, often in general terms, and turned over to federal agencies to fill out the details and determine the regulations required to carry out the requirements of the law.  Congress simply doesn’t want to be bothered with the details. When it doesn’t work as they assumed it would — and laws seldom do because they attempt to direct the actions of 310 million cantankerous individual people who are not a large, cooperative band of sheep — they just layer on another law or more regulations to fix it. And so government expands, getting ever bigger and ever less efficient. On top of that, layer government unions which mean that nobody can get fired, and nobody is responsible and corruption grows.
A  new New York Times survey shows that 54 percent of Americans say “over-regulation” that may interfere with economic growth was a bigger problem than lack of regulation. Only 54 percent? They said that they were more concerned about damage caused by excessive government regulation than by inequality caused by the economic system — a response surely troubling to Democrats who are deeply concerned about inequality and sure that more and more regulation will fix everything.xDemocrats-copy.jpg,qresize=480,P2C320.pagespeed.ic.utsZF-5JhebEhPXMzjhd

Improving Health Care One Step At a Time by The Elephant's Child

The Wall Street Journal in their regular “Notable and Quotable” column featured an excerpt from Dr. Atul Gawande’s radio talks for the BBC’s annual Reith Lectures, delivered December 2 in London:

And so we were approached by the World Health Organization several years ago with a project to try to reduce deaths in surgery. But how can you possibly do that? But it was exactly the same kind of problem—the basics were known but not necessarily followed. And so we worked with a team from the airline industry to design what emerged as just a checklist—a checklist, though, that was made specifically to catch the kinds of problems that even experts will make mistakes at doing. Most often basically failures of communications. The checklist had some dumb things—do you have the right patient . . . But the most powerful components are: Does everybody on the team know each other’s name and role? Has the anesthesia team described the medical issues the patient has? Has the surgeon briefed the team on the goals of the operation, how long the case will take, how much blood they should be prepared to give? Has the nurse been able to outline what equipment is prepared? Are all questions answered? And only then do you begin.

We’ve all seen the scene in movies, and watched the pilot and copilot go through the checklist, no matter how urgent the takeoff is, and we can probably assume that the movies get that right, it’s the kind of thing they like to get right or they would get calls and letters from thousands of pilots, and be laughed at.

After they tested the checklist in eight cities around the world, London, Toronto, Seattle, Delhi, Tanzania, and in every hospital that used it complication rates fell by an average of 35%. The average reduction  in deaths was 47%. Scotland implemented it and taught it at the frontlines and they demonstrated that 9,000 peoples lives have been saved over the past four years.

They asked surgeons for their opinions after using it for three months. About 20% really disliked it, thought it a  pain in the neck. Asked “If you’re having an operation would you want the team to use the checklist?” Ninety-four percent did. “The discipline,” Dr. Gawande said, “is what makes daring possible.”

Atul Gawande M.D., MPH is a general and endocrine surgeon at Brigham and Women’s Hospital, professor in the Department of Health  Policy and Management and the Department of Surgery at Harvard Medical School.

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