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Notes -
Two case studies in government waste:
As you can likely imagine right now a lot of people in medicine are sharing tales and taking sides in the great DOGE debate. Two that popped up on my radar and stuck out to me:
Some problems: -As an emergency room most of their patients have no insurance or Medicare or Medicaid, meaning the facility often get paid less than cost. They only stay open at all because of their state grants.
-Many of the patients are drug addicts or malingering (because of homelessness for example). Every day you’ll hear something like “you’ve been here every day for the last three weeks” or “have you considered stopping using PCP? You always seem to fight with the police when you do” and “here’s your follow-up appointment, will you go? No? Fuck me? Okay thank you have a nice day.”
-Many of the patients who do actually have mental illness are in denial about it, or have some sort of limitation that prevents them from attending aftercare appointments.
-The “best” solution is probably to violate patient rights and involuntarily commit them to make someone else be on the hook for making sure they go to their aftercare.
-In the meantime, the hospital has hired several additional staff to manage some of the administrative complexities associated with this change (for example hammer calling the patients to remind them to come to the appointment). They have also hired night staff whose job is to sit in an office overnight purely to schedule appointments with an outpatient program (otherwise no patient could be discharged overnight because they wouldn’t have an appointment to go to…).
Anyway, he dutifully completed his requirements in a timely fashion (which were all pointless! Ex: what is the motto of the VA???). So, months later his rotation is starting soon. He begins the process of emailing the education team once every 2-4 business days. You have to email them multiple times before they respond. The conversation goes something like this over the course of multiple weeks, “I think I’ve completed my onboarding do I have to do anything else?” “no” “okay is my onboarding done” “no” “okay when can I pick up my ID card” “when your onboarding is done” “I thought my onboarding was done” “yes” “okay what I am waiting on” “nothing.” I have seen the emails; it really looks like this.
At this point his program tells him to CC the chief of medicine at the VA hospital, at which point the person responds with “okay we put in a ticket for this a month ago, your training is complete but your training is marked as incomplete.” A screenshot has been attached that shows the request and an automatic response that says something about high ticket volume and that they will get to it at some point. The chief of medicine replies “….does the trainee need to do anything?” (we are here).
The resident will be able to rotate but will not be able to do any work without computer access.
It’s worth noting that the VA is paying for this resident to be there, despite the fact he will in fact not be able to do anything. At his last VA rotation (yes they go through this for every resident every time) he was six weeks into an eight week rotation before he got access.
I do find myself occasionally wondering if the local abandoned Walmart (shoplifting killed it) might be a fine place for a novel nonprofit to set up an indoor tent city for the local homeless, with security guards and nurses on staff, a doctor dropping by every day for prescriptions, and the in-store pharmacy restored to full functionality. The big outdoor parking lot might be additional space for the hardier hobos willing to rough it.
That’s impressive. It is difficult to kill a Walmart.
I don't know about the US, but the toughest stores here are dollar stores. I don't think I've ever seen one die.
I’ve seen dollar stores die. It’s gas station convenience stores(in local parlance- ‘corner stores’) that won’t die.
Near where I used to live we had an intersection where three corners were gas stations and the other corner was a 7-11, no gas.
It's a four lane divided road. The gas stations on the far side of the intersection, where one could take a right after passing through the intersection, and then take another right to continue on the same route, have always had the same branding and ownership.
The one gas station that was on the near side, where you'd have to exit and be immediately at the stop light, would change ownership every couple of years, and eventually failed completely.
Traffic gets very backed up in this area, and I'm guessing people didn't want to deal with re-entering with a line of cars that wouldn't be kind enough to let them in. Just a few seconds further would take you to a station where eventually traffic would get blocked by a red and you could re-enter without depending on the kindness of strangers.
That property sat unused for about a decade, reportedly because of the great expense involved in neutralizing the underground gas tanks to meet environmental standards.
Fun fact: One of the downsides of roundabouts is that they do not provide these breaks in traffic, so they can cause problems downstream.
They can also cause problems upstream:
(Assumes driving on the right / CCW flow through the roundabout.) If you have a roundabout with heavy traffic flow from, say, the South entrance to the West exit, you can get perpetual backups for traffic coming from the East.
And then you have to do goofy stuff like "traffic-metering signals", which turn the roundabout back into an old-fashioned traffic circle…
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