*Cable service people who can’t ever seem to get a cable guy to your house.

I came home Friday night to find that when the cable guy came to turn off my downstairs neighbors cable (they moved out earlier in the week) they turned off mine instead.  The company refused to even look up that information insisting that their records showed that my cable was not turned off.  Yeah that’s why I had no tv and no internet.  Buttheads.

It sounds very much like the McCain approach to health care is very much like the Bush approach to airline security.

A huge amount of low level gatekeepers are given minimal training to act as the barrier between customers and service. The gatekeepers are constantly reminded of the importantce of thier job (i.e.  terrorists terrorists terrorists, or “health care fraud, overcharging, fraud fraud fraud) and are given a fairly arbtrary list of things that have to prevent but no real latitiude to deal with the nearly infinite combination of actual situations they will encounter. (Is breast milk a disallowed liquid… is a congressional medal of honor a sharp object? or Sure it’s probably a glass shard that’s embedded,  but they need to take an x-ray first… Sure the drug has been on the market for three years and it has few side effects than the generic, but according to our list it’s still “experimental”)

So the result is a regimentited attitude among the gatekeepers that generally fails to serve the consumer and a gereral disincentive to deal with the situations not covered by the “important list” which leads to a general runaround. 

I want bureaucrat who are empowered to make decisions and have access to real information, not gatekeepers who are given a spreadsheet, a checklist and a quota!

McCain would have a damn hard time getting health insurance if he didn’t get it from the government.  Five and a half years of regular beatings have left him with all manner of preexisting conditions, not to mention multiple bouts of melanoma.

Federal bureaucracies consists of lifetime government employees with no profit motive to drive best practices and no consequences for deliverying bad customer service or to work one second past 5 o’clock.  If service is rendered or not, they get paid and their company (the govt.) gets funded.

Bad customer service comes from economic advantage: a semi-monopoly situation (like cable), a plethora of customers so no one customer is that important (think cell phone companies), or being the holder of the purse strings (insurance companies).  They are not bureaucracies.  They are profitable enterprises making very intentional decisions on how badly to treat their customers because it does not hurt their bottom lines.  That is not a bureaucracy.

Its inconceivable to many Republicans that private health insurance companies could possibly have any bureaucratic problems because of their hard on for the private sector.

So many points I wanna make…

First, I worked for the state health department for a year or two, and no one there ever talked about how to keep people from getting treatment—the emphasis was always on getting more treatment and more information and more resources out there for more people.

Second, the best comparison I’ve ever had for private vs. public sector has been the Post Office vs. UPS/FedEx. I’ve had so many packages mis-delivered, lost, delayed, or damaged by UPS and FedEx that I do everything in my power to get my packages sent by the Post Office.

And finally, seems like it’s been ages since I heard some asshole fartknocker stand in line at the Post Office and start bitching about how slow the line moved—“This is what we pay our taxes for” and all that jazz. I assume I never hear this anymore because I’ve already resolved to tell the next fartknocker I hear that they get the service they voted for and giving the Post Office enough money to hire more employees would certainly improve the quality of service.

They’re speaking to their base and the middle, not the everyone.  The rethugs have spent three decades demonizing everyone in government including the institution itself (unless said government people are repbulicans).  This is just more of the same.  It will play to the suckers and fools it’s always played to. 

The real question is and continues to be, how many people will vote for another bush administration? 

Lather.  Rinse.  Repeat.

Ms Kate: You and Dr T just agreed, at least on the most important part. Insurance companies screw individuals because they have the power to do it and they gain an advantage by doing it.

The biggest reason why health insurance in the U.S. is so much worse than, say, car insurance, is simple. Individuals don’t get to choose their insurer. Their employers do. As long as the employer is happy, the insurer can be as mean as they like to the individuals they cover and the individual has to shut up and take it.

Strange perhaps, but I’ve never had a problem at the DMV.  I started driving in NY, and have since moved to MA (with all the requisite new licenses, title changes, etc.).  I’ve always encountered pleasant, helpful people, and got done what I wanted to get done.  Now, the thing is, when I go to the DMV, I make sure I have all the paperwork and documents I need, so that I don’t annoy the clerks.  Same thing with the post office.  I’ve noticed that many people go to the post office without knowing what it is the really want, so they end up asking for things that can’t really be done.  In either case, taking a couple minutes to understand the system, and what you need to do to make it work makes all the difference.  Reading the websites, for example, and calling before going (especially that the DMV) if you have questions.

The only person standing between your doctor and you is your insurance company, if you have insureance.  My friend was recently diagnosed with a fast growing cancerous tumor in his throat.  He can get the tumor removed which will severly damage his vocal chords and he will have speak with a one of those vibrating amplifiers OR he could have chemo/radiation treatment first to shrink the tumor, then have it removed with NO damage to his vocal cords.  Guess which one the insurance will pay for?  Correct, the lose your vocal chord option, it’s the cheapest option.  They also told him that his visits to the specialist were not covered because the doctor wasn’t on his plan.  So much for getting to see the doctor you of your choice.

Now onto buearacrats.  I am a city planner and always try my best to assist citizens, they (and I) after all pay my salary.  I am constantly being told how incompetent city employees are.  It has been my experience that most of the time the citizen was given the corrent info, but simply didn’t listen, or didn’t understand and never asked any questions.  We should also remember, a lot of the employees on the front lines only have high-school educations and aren’t paid a lot.  They have to put up with people who walk in assuming they are idiots and treating them as such.  Most city employees take pride in their jobs and really do go above and beyond.  I have worked many a weeked, with no overtime pay.  I have to drive my own car on site visits, without compensation.  I used a half of tank of gas yesterday doing site visits.

This all goes out the window when the state bureaucracy in question doesn’t see you so much as a client as a leeching thief that should be cut off the system as soon as they find a technicality that allows them to do so.

If the health care bureaucracy in Quebec is decent compared to the hellhole of insurance bureaucracy, you really don’t want to have to talk with the bureaucrats in charge of approving (or verifying you are still eligible for) your welfare check. The attitude is one of barely hidden contempt.

When it comes to health insurance, one way or another you’ll be dealing with a huge and impersonal bureaucracy. The question is, do you want that bureaucracy ultimately beholden to private shareholders driven by profit (as it is now) or the tax-paying citizenry driven by access to healthcare for themselves (as end-users).

That’s what it comes down to. Usually stops the opponents of universal healthcare right in their tracks.

Seriously, thank god for the empowered bureaucrat.

Yes. Unfortunately, the empowered bureaucrat an increasing rarity. As you note, tasks are getting more and more tied to micro-managed and inflexible SOPs, and thinking for oneself is discouraged.

The un-empowered bureaucrat, especially the one who uses the lack of choice in his job to engage in petty power trips on customers, is far more common. All brought to you by the Human Resources Culture (or what John Taylor Gatto calls “The Fourth Purpose”) [PDF link].

Look, no one likes going to the DMV, but one reason government bureaucracies are a pain in the ass is that they’re not properly funded.

Which is exactly how the Republicans plan to hobble any public healthcare system. They’re all about the self-fulfilling prophecy.

And now for the champion of the Invisible Hand…

Federal bureaucracies consists of lifetime government employees with no profit motive to drive best practices and no consequences for deliverying bad customer service or to work one second past 5 o’clock.  If service is rendered or not, they get paid and their company (the govt.) gets funded.

Profit motive doesn’t necessarily drive best practises in private bureaucracies, either—often it results in corner-cutting that leads to the typical results you see. Monopoly or oligopoly status only increases this tendency, but they aren’t the primary drivers of bad practises. Furthermore, public-sector status (where the “shareholders” are also the end-users) can mitigate this problem with the proper structures.

Also, I have no problem with a salaried employee refusing to work more than 9-5, or whatever his hours are—if they’re not getting their allotted tasks within that time (various breaks included), what has to be examined is performance, management expectations, and whether the proper resources are present to do the job. Accountability is a two-way street, and management (especially the MBA holding type) is often just as incompetent as labour. And all too often, there’s a “glass floor” in place that keeps that kind of manager from getting fired or demoted for his bungling.

I believe you work in the videogame industry, a wholly for-profit sector which is rife with bad practises, from the leaders (like EA, with its eternal crunch-time) on down. Software and Internet development in general is only slightly better—lots of managers who’ve never even heard of Fred Brooks, and lots of young and naive employees who are so blinded by the Nerf-fights and “free” soft drinks that they don’t see how every extra hour they spend at work because of those managers diminishes their hourly earning power.

I’ve actually never had a bad DMV experience. Maybe that’s because I work in customer service and I know what it’s like to be spat upon figuratively while trying to do your job, so I make it a point to be a sweetheart to the people helping me.

Isn’t anyone going to mention McCain’s plan?  His plan to eliminate the tax breaks employers get on the health insurance they provide to their employees?  At the moment, I pay about $1800 a year in insurance premiums.  My employer pays $5,000.  If McCain eliminates the tax break on that my employer will have a number of options:  1.  Eliminate my health insurance completely.  2.  Pass on some, most, or all of that cost onto me.  3.  Choose an even shittier plan than the one they already provide.  4.  Stop giving me raises, and my last raise wasn’t even enough to cover the increase in cost of living.  Thank you so much asshole McCain.  That will really help me and all Americans get better health care coverage.

Amanda, the movie Gangs of New Yorks had a pretty nice example of how ‘for profit’ firefighter squads would work out, in practice.

Namely, fistfights break out between the competing departments while neighbors loot the burning building.

Libertopia!

That was about Gangs of New York.

Amanda, the movie Gangs of New Yorks had a pretty nice example of how ‘for profit’ firefighter squads would work out, in practice.

I’m thinking it would be like pizza delivery…ooh, sorry, we don’t service that area.  What if your house sets on fire the day before payday and your check doesn’t get approved by the electronic check-clearing service?

Dr. T:

A bureaucracy is an organizational method by which labor is separated into specific departments with a specific job. Yes, private insurance is set up on a bureaucratic model. It’s the most efficient way of performing certain tasks. A bureaucracy can be amazingly efficient at routine tasks, because each office has a specific job to do and each person can become highly skilled at that specific job. Of course, non-routine tasks can be a pain. If you’ve spent your entire time at the office checking vouchers, looking for outstanding receivables, then calculating best time to pay, and handing it off to the next person in line, you’ve probably forgotten how to accept a payables check that is returned as an overpayment… and someone is going to spend a lot of precious time with you trying to give your company back its own money. You might accidentally transfer them to recievables, who can’t help because there’s no sale associated with the money, so they might get transferred to the general ledger folks who can’t cut or accept checks, who might transfer them to payroll, thinking the “overpayment” is an employee paycheck that was overpaid….

The word is overused and has become diluted because of that. It’s not uncommon for people to speak about bureaucracy like it’s some evil thing from the depths of hell, but all it is, is a description of a way of breaking down duties and getting things done.

Like Ezra said, the government bureaucrat’s job would be to make sure that the insurance company bureaucrats can’t stand between you ...

VERY nice juxtaposition…for me.
Of course that type of middleman exists in and for both governance
and the more business, commercial sorts and ends of things, but..

I have spent a lifetime thinking fairly strictly of bureaucrat as agent of Government.
Pigeon-holing that way every time.

A sort of anciene embedded sort of perceptual blindness.

So thnx

My only real experience with government bureaucracy is with USCIS (immigration) and I have to say that it is in fact the most frustrating, inefficient, absolutely inexcusable clusterfuck you can imagine.  It is literally impossible to get a human being on the phone if you do not have a case number to put in the phone menu.  Good luck getting things straightened out if the thing went haywire BEFORE the step where the send the case number to you.  There is no way to just ask a simple question like “should I use my current married name or my maiden name since that is what you have on all my other records?” without making an appointment (always at least 2 weeks out) to go across town and ask someone through a window (who might not tell you the right thing, who knows).  There is also ZERO accountability, since nobody gives you a name or employee number, so if they give you bad info you are SOL and probably going to get deported and you can’t even say “well, Joe at the call center told me to do it this way.”

And all that stuff is just with the agency stateside.  They are a breeze compared to being a foreign national dealing with the US embassy in your home country.  All the same problems PLUS less technology and organization and they are even more disrespectful to you as a person.

This would be annoying if you were dealing with some private company.  You could always take your business elsewhere.  It is absolutely gut-wrenching when you are struggling through this and they get to decide the OUTCOME OF YOUR LIFE and there is nobody else to turn to.  I wish these people knew how many hours of weeping they have caused me.  It should be a crime.

And I am a college educated native English speaker dealing with this stuff for my husband.  I cant even imagine how an immigrant with English as a second language would handle it.  Plus the cost of every round of paperwork is in the $1000 range, so good luck paying that and hiring a lawyer to do this stuff for you.

Sorry for the rant.  Maybe other branches of the government are better but USCIS could hardly be any worse.  I am sure that doing this with an insurance company would be just as bad since it can be a matter of life and death.  Maybe what we need it just a little more funding for all of these things and more general human compassion.

My only real experience with government bureaucracy is with USCIS (immigration) and I have to say that it is in fact the most frustrating, inefficient, absolutely inexcusable clusterfuck you can imagine.

Well, yeah.  The government wants to discourage immigration, and one way of doing that is creating the image that immigrating is impossible. Which is best done by making the process a royal pain in the ass so that people will complain about it, and word of mouth will get back home that seriously, just don’t even bother, because it’s not worth it. 

It’s the same with my main foray into government bureaucracy—- collecting unemployment insurance.    If you don’t collect, your company gets to keep the money (even though, no, it’s not welfare but part of your wages).  Thus, they make the process an ordeal in hopes that people won’t even bother. 

On the other hand, when the shoe in on the other foot, government bureaucracy is a walk in the park compared to corporate bureaucracy.  I recently had a breeze of a time going through jury duty.

“Dr. T, define “best practices”.  Because private companies have a “best practices” incentive of denying services to increase profit.”

Agreed, certain economic circumstances allow that not delivering a service is more profitable than actually delivering the service.  The point is not that there is crappy customer service occurring in private companies, because there most certainly is.  The point is that it is not because of a bloated, unmotivated, multiplayered beuracracy that has absolutely no incentive nor actual ability to deliver customer service.  It is because a conscious decision has been made not to deliver customer service.  Both are bad for the customer, but I would posit that choosing to screw people is a great deal worse than screwing them out of ineptitude like the government does.

This post made me realize something I’d never thought of before.

My dad’s career with the DOD was as a “contract manager.” His role was to ensure that all contracts between the Air Force and private sector defense contractors (Boeing, etc) complied with federal laws. In the final phase of his career, his job also involved ensuring that a certain percentage of USAF contracts were awarded to “small businesses” (according to the Federal definition of that phrase).

So, according to the GOP, my father was not a proud participant in the nation’s military-industrial economy, but was in fact a government bureaucrat standing between Lockheed-Martin and their money.

Thank you Scott and Amanda! for your defense of the USPS.  I retired from the post office some years back, just as “modern” procedures were being put in place to assure less involvement by actual employees in the delivery process. 

While I was working, when people used to rag on me about FedEx and UPS, I would tell them that whenever those guys can’t find an address, they ask ME, and I can always help them out.  And THAT’S why they have such a good record.  Also, in remote areas (and you’d be surprised what they consider “remote”), they just take it to the little “remote” post office and mail it the rest of the way.

And by the way, I am not talking about Remote, Oregon, which actually IS remote.

The point is that it is not because of a bloated, unmotivated, multiplayered beuracracy that has absolutely no incentive nor actual ability to deliver customer service.  It is because a conscious decision has been made not to deliver customer service.

Dr. T., the problem is that in the private sector you have conscious decisions to screw the consumer in conjunction with bloated, unmotivated, multilayered bureaucracy that has absolutely no incentive nor actual ability to deliver customer service.

Dr T:

Both are bad for the customer, but I would posit that choosing to screw people is a great deal worse than screwing them out of ineptitude like the government does.

Sure, because it’s always better to be screwed by someone who doesn’t care about you than by someone you don’t care about. Or something.

Jeebus. Libertarianism really is just grade-school bullying writ large, isn’t it? “I may be getting screwed by the big guy, but at least I have someone lower on the socio-corporate ladder to fuck over.”

Dan - What are you talking about?  There are huge implications to services that can be vs can’t be delivered because of business structure.  In health care, for instance, the government could require that companies respond to a claim in a certain amount of time (either positively or negatively), and require boards dedicated to appeal which also have required turnaround times.  That is not in the interest of the insurer so they will never do it on their own, but it is not that they CAN’T do it.

In health care, for instance, the government could require that companies respond to a claim in a certain amount of time (either positively or negatively), and require boards dedicated to appeal which also have required turnaround times.
-Dr. T

Won’t this just bring beaurocracy (the thing you’re trying to avoid) into the equation.  Rather than “having a beaurocrat standing between you and your doctor,” you’ll have one standing between you and the speedy response to your insurance claim.  Same difference.

I have never once had an unpleasant experience that was the fault of the employee I worked with at the DMV. Long lines, screaming babies, people that smell weird, yes they’re all in abundance. But when I get to the window I’ve always been given a smile, sorry-about-the-wait, and helpful service.

Bank employees, on the other hand? DIE IN A FIRE, ASSHOLES.

“Won’t this just bring beaurocracy (the thing you’re trying to avoid) into the equation.  Rather than “having a beaurocrat standing between you and your doctor”

Nope, not if properly managed.  With electronic claims submissions and tracking, the govt agency could monitor timeliness of response.  The govt only steps in when the company violates the timeframe - not every time, and if the penalty for not responding is autcoverage of the claim, the insurance companies would answer in a timely fashion with no isses.

Of course the flip side is that they would raise rates because denying claims is part of their profit strategy and if that loophole is closed then they’d have to make up the profits on the frton end - but that would provide a truer cost of health care than taking people’s money for insurance and simply ignoring them does.

The point is that it is not because of a bloated, unmotivated, multiplayered beuracracy that has absolutely no incentive nor actual ability to deliver customer service.

You haven’t worked for a large corporation recently, have you?  Because I can tell you that having to deal with a huge, bloated internal bureaucracy is just as frustrating—if not more so—than dealing with an outside one.  And they have even less incentive to help because, hey, you’re just a fellow employee trying to get their job done, and if you don’t get your job done, you’re the one who’ll be in trouble, not them.

“You haven’t worked for a large corporation recently, have you?”

I have in the past - General Electric to be exact, and as soon as profits started to fail they took out layers of unproductive workers (see bureaucrats) to restore profit and streamline the workflow.  Doesn’t happen for the Federal Government.  There we just spend into a deficit.

My only real experience with government bureaucracy is with USCIS (immigration) and I have to say that it is in fact the most frustrating, inefficient, absolutely inexcusable clusterfuck you can imagine.

I know what you mean, having dealt with them years ago as the INS.

There’s a reason why that particular agency is filled with the most incompetent, paperwork-losing, surliest staff imaginable, and that reason goes right to the issue of accountability. Unlike other Federal agencies, the people they’re “serving” are not citizens and are not necessarily paying taxes. That gives the agency extreme license to be lax or even hostile in their customer service.

I suspect that, for that reason, the immigration agency has been a dumping ground for particularly incompetent and unhelpful Federal bureaucrats, and that over the years such people have percolated up into management and supervisory positions, infecting the organisational culture.

Plus, as The Opoponax said, in a time when the GOP has to pander to anti-immigrant Know-Nothings, this situation becomes a feature rather than a bug.

I have in the past - General Electric to be exact, and as soon as profits started to fail they took out layers of unproductive workers (see bureaucrats) to restore profit and streamline the workflow.

Using those wonderful peer evaluations from HR, I’m sure. If merit and productivity and performance were the criteria for BigCorp layoffs I wouldn’t mind them. However, we all know that it’s much about personality and politics and arse-covering and seniority as it is about who contributes real value—just like in government bureaucracies (well, maybe it’s just a little more performance-based in government, where guidelines can be strict).

“Nope, not if properly managed.”

We seem to be back to square one here, Dr. T.  You’re describing a system in which the boss of the manager in question is the insurer, not the insuree.  Consequently the manager’s job will be to keep the insuree away from services that might increase the insurer’s costs, not to see that the insuree gets access to those services.  “Proper management” in a system where the client is the boss means one thing; “proper management” in a system where the insurance provider is the boss means something totally different.  The reason for this is not far to seek.  In the first case, the manager (or bureaucrat) is working for the client and is paid to serve the client’s interests.  In the second case, the manager is working for the insurance provider and is paid to serve the interests of the insurance provider.  This is a pretty simple concept and I don’t see anything about it that ought to be difficult to understand.

“With electronic claims submissions and tracking, the govt agency could monitor timeliness of response.  The govt only steps in when the company violates the timeframe - not every time, and if the penalty for not responding is autcoverage of the claim, the insurance companies would answer in a timely fashion with no isses.”

So you need the government anyway, Dr. T, in order to work your plan.  (Curses!)  Want to know what will happen?  The insurance companies will start to hand more and more of their cases off the government in order to save on their costs.  They will also become much more reckless because they know that Uncle Sam will be there to bail them out.  The prices of stocks connected with insurance companies and health care concerns will rise, while at the same time the health care sector will (mysteriously) become even more occluded and irresponsive than it is now.  Americans will eventually end up paying two sets of health care providers: they’ll be paying the insurance corporations and other health care industry entities to deny them coverage, and they’ll be paying their government to provide them with coverage/health care in the end…after much frustration and heartache and a few incidental deaths along the way.  Ultimately I wouldn’t be surprised to see a gigantic bailout of the health care sector, courtesy of the American taxpayer, just as we’re now seeing a gigantic bailout of the housing sector, courtesy of that same American taxpayer.  Costs will be socialized, benefits will be privatized, and most people will end up measurably worse off.

There are, of course, a number of shortcuts we could resort to in order to avoid all this unpleasantness, but those would involve “socialism” and we couldn’t have that.

When McCain said this, I immediately thought of Medicare.  It is, after all, “government run health care system where a bureaucrat stands between you and your doctor”  (it also has a lot lower cost per-claim than any of the big Commerical companies, and that includes the Blues).

Somebody should tell the AARP that John McCain wants to take their Medicare away.  Yeah, I know, that’s not true per se (although more true than most Republican claims), but Medicare sure fits the description of the big bad socialized health care system he wants everyone to avoid.

McCain would have a damn hard time getting health insurance if he didn’t get it from the government.  Five and a half years of regular beatings have left him with all manner of preexisting conditions, not to mention multiple bouts of melanoma

well he could take advantage of his local VA for care but these days, that may be more of a threat than a promise.  Could you imagine if he had been treated like the maimed soldiers returning from Iraq are treated today?

“I suspect that, for that reason, the immigration agency has been a dumping ground for particularly incompetent and unhelpful Federal bureaucrats”

You said it.  My husband was in Kenya waiting for his case to be processed during the post-election violence last year and I was so desperate to get him out of there I had to call up and beg USCIS in a longshot attempt to get him bumped to the front of the line.  After at least 30 minutes of mashing buttons on the automated phone system I got a person on the phone and had her direct me to one of the higher-ups.  Even though I was obviously shaken and crying (what with my partner being in imminent danger of decapitation and having to tell it to people who have no reason to care) and this guy was straight up MEAN to me.  I had to ask him to repeat himself because of a bad connection and he was like “Come on, you are not listening. I am gonna talk REALLY slow so you can MAYBE get it this time.”  What an ass.  Even if you are not normally civil to your customers, maybe you could hold back the dripping contempt when you are on the line with the weeping lady?  Seriously.

Using those wonderful peer evaluations from HR, I’m sure. If merit and productivity and performance were the criteria for BigCorp layoffs I wouldn’t mind them.

Actually, my experience is that government jobs are even more assiduous about making sure all employees have detailed goals set for the year and have their performance documented on a consistent basis regarding whether or not they met their goals.

My only real experience with government bureaucracy is with USCIS (immigration) and I have to say that it is in fact the most frustrating, inefficient, absolutely inexcusable clusterfuck you can imagine.

Government is ultimately accountable to the voters. Whom does immigration serve? Non-citizens, who can’t vote. Thus, there’s no political pushback to force the agencies to improve.

Geez, my brother is in process to join his wife in Canada.  Civilized breeze by comparison.

Those nasty socialists!

I’ve worked for government on and off for 20 years and I wish I’d experienced some of these allegedly bloated bureaucracies Dr T talks about. My experience has always (always) been that there is never enough money to go around. There is always penny pinching, there are never enough resources and there are never enough people to deliver the services that the tax payer expects you to provide.

I’m currently CEO of a small government agency. My people do incredible things with very few resources. They are entrepreneurial in the face of budget scarcity, they think laterally, they work long hours. Why do they do this? Because they are passionate about their jobs and about helping the people who use our services. They may sometimes be misguided, they may sometimes not see the woods for the trees, but they don’t stop caring. I find that both amazing and awe-inspiring.

Are there bad bureaucrats out there? Sure there are, but they don’t just exist in government. And mostly they are the fault of really, really poor management. There are some shocking CEOs out there and a lot of them exist in the private sector. If people are giving you bad service, look to their leaders.

My own experience with the CSIS was when my noble bride turned in all the paperwork to help get her siblings here via her mother in Feb 2005, she had to resubmit them in Sept. 2006 because they hadn’t gotten around said paperwork and the financial data was ‘out of date’.

This meant a lot of time, effort, and money expended for the same thing for something that wasn’t in our control.

They piss off a lot of resident aliens who can’t vote and aren’t likely to complain because of cultural differences between Patriarchal Village, NOTTHEUSA, where they were born and raised, and our belief that ‘The squeaky wheel gets the grease’.

I have in the past - General Electric to be exact, and as soon as profits started to fail they took out layers of unproductive workers (see bureaucrats) to restore profit and streamline the workflow.

Funny—at my large corporation, and all of the other ones I’ve worked for, they lay off the support staff and the people doing the grunt work and give middle management a bunch of bonuses.  Then they wonder why the bills aren’t getting paid and they’re racking up late fees.  Hey, genius, maybe it’s because you laid off all of the people who were actually processing the payments and the managers you left in charge have no idea how to run the system!

It’s a huge deal when the real corporate bureaucrats—the managers, directors, and vice presidents—get laid off, because they’re pretty much untouchable in the modern corporation.

But, yes, I’m sure that IBM was much more efficient after they got rid of a bunch of line workers and administrative assistants and their bosses got to spend the next 12 months trying to figure out who was going to create the purchase orders and keep the kitchen stocked.

Actually, my experiences with the DMV have been fast, helpful, and usually friendly. The key is to make an appointment.

P.S. my latest temp job was at a junior college bookstore. I was told to advise students to postpone purchasing optional texts until they knew for sure that they would find them useful. The permanent workers expressed frustration with the teachers who picked more expensive texts and respect for the ones who actually thought about cost to the students. Used books HAD to be placed to the front and on top of new, so they would be easy to see and access. One of the managers in charge of vouchers had a talk with us temps about how to help the students get the most for their money. And students were free to take all the info they needed so they could try shopping on line—we even had pencils and scratch paper if needed.

(Yes, the individual insurance market is also messed up, but that’s not the problem my parents have.)

There’s another big problem with health insurance in the United States.

Specifically, it’s not insurance. People don’t seek health insurance in the U.S. to protect themselves against catastrophic losses. People seek health insurance in order to get health care. This is the result of a bizarre quirk in the tax code that subsidizes employer-provided health care. If you have a deductible of less than, say, $5000, your “insurance” is, most likely, simply subsidized health care that calls itself insurance. It’s like buying car insurance in order to pay for oil changes.

From a certain perspective, buying health insurance is like often like buying fire insurance for a building that’s already on fire. If you’re already sick - in other words, have a “pre-existing condition” - there’s no uncertainty involved, no “risk” being “insured” against. All you’re doing is going to someone and saying “I’ll give you X dollars, and you’ll pay for my medical care, which will cost Y dollars.” If X>Y, it’s silly for you to make that offer, and if Y<X, it’s silly for the insurance company to accept. If not for the bizarre quirk in the tax code, it would be usually be cheaper for you to pay the medical bills directly, instead of having your employer pay an insurance company to pay the medical bills for you.

If you’re in the business of collecting money from a lot of people in order to give much of it back to those few who get into trouble later, you’re an insurer. If you’re in the business of giving money to people who are already in trouble, then you’re a charity. Insurance companies aren’t going to act like charities, no matter how much we try to use the law to force them to. Governments are a lot better at charity than for-profit corporations, which is why I would greatly prefer to pay for my health care through taxes that go to a government instead of premiums that go to an insurance company.

In other words, we have neither a “free market” in health care nor socialized medicine in the United States. Instead, we somehow ended up with the worst of both worlds. I support socialized medicine, because, given a choice between living in a country that forces some people to pay for others’ health care or one that lets people suffer and/or die because they don’t have the money to pay for it themselves, I’d rather live in the former.