Last week, we ran an article about problems afflicting Medicaid. Part of that piece spotlighted a problem with West Virginia’s state level Medicaid fraud unit. The United States Department of Health and Human Services Office of the Inspector General determined that the unit functioned mostly well, but had failed to report malefactors either at the patient or the practitioner level who committed fraud or abused the system.
Investigators found that there was no intent to avoid adding these subjects to the national database, but confusion reigned in a department with constant staff turnover and lack of training.
This reminded me of an incident when I worked for Congressman Alex Mooney’s office. Congressional offices switched to a new data system designed by Northrup Grumman and district staff got one day in DC to train for it.
It had all of the bells and whistles and boasted amazing capabilities, but required complex knowledge and understanding to help it to reach its full potential.
The training session included myself, who directed the Martinsburg office, the Charleston-based district director and several others. Training went well in the morning, but the technician doing the teaching rushed through the last few hours.
All got out an hour early, but only three people understood what had been taught.
The Congressman put a premium on hiring individuals with personal effectiveness and problem-solving skills. Those skill-sets often do not match up with technical expertise. Eventually staffers who understood the system took care of the data and almost everyone else avoided it as much as possible and got by as well as it could.
There is no way that this extraordinarily expensive and complex system provided enough benefit to mitigate its cost and the difficulties incurred in using it. Planners bought it assuming the best case scenario of staff for whom the digital realm served as their natural habitat, not a range of ages from a 19 year old office assistant to an octogenarian former State Legislator.
The 19 year old ended up one of the most proficient at helping others use the system. Congressman Mooney’s staff attacked casework with gusto and found workarounds to the system, delivering great constituent service, but the records and data system was a hindrance and not often a help.
This pattern likely repeats across the federal government. The Department of Government Efficiency ought to examine this issue through the lens of an intimidating mountain of complexity facing administrators who intend to do well, but end up hamstrung.
Another issue of the “best case scenario” serving as the enemy of the good lies in an example far afield from congressional offices.
For three years, I was in teacher education at Marshall University. A pattern existed in the textbooks used for educational psychology and other teacher education courses that all but a handful of instructors parroted.
Aspiring teachers learned from texts that assumed a perfect classroom full of children excited and eager each day to learn. The educational system obviously wanted to mimic this approach, because in this same era school systems started passing block scheduling, expanding classes from the 45 to 55 minute “Carnegie Units” to two hours or more.
A pat answer existed to questions of what happens if students do not demonstrate eagerness to learn or excitement to come to school. That was almost always “teach better.” It implied that teachers who had difficult students – or whose classes were full of people bored with a certain subject for two hours – were the ones at fault for imperfect results.
How much damage did that “pie in the sky” approach do to teacher morale, individually and collectively – especially as the 21st century and its myriad problems of social degeneration struck?
Carnegie units came from research in how long an individual could productively tolerate a subject they did not like. If a student hates math and does not perform well at it, almost no teacher will inspire love of that subject in 45 minutes. Two hours enduring such a situation becomes downright counterproductive.
They reflected the reality of mass education, as opposed to those who wished for a different scenario.
Assuming the best case scenario and expecting results based on it stems from lazy application of policy. It conveniently ignores that Aristotlean reality brings more complexity than idealistic theory or planning, but places the blame squarely on those who try their best with less than perfect tools at their disposal.
And all too often, government protocols and regulations stifle any initiative on better ways to deal with such issues.
That does not mean that the pursuit of excellence should be abandoned, but that one must start where the subjects are and go from there.
Wisdom teaches that one should expect the best, yet prepare for the worst. Perhaps one of the biggest follies of government has lain in, from time to time, simply expecting the best while remaining blind to either how to get there or even what that looks like.
