The Business of Healthcare

Why the Lack of Power Corrupts Absolutely: Dealing With Petty Bureaucrats

A few months ago, while waiting at the gate for a flight, I couldn’t help but notice a gate agent making some woman unpack and repack and unpack and repack her expandable carry-on suitcase because it was too wide to fit into the measuring “box” for carry-on luggage.

It was obvious from the gate agent’s face that she took sublime pleasure in the exercise of her “power.”

When I commented to her a few minutes later that I next expected her to make the woman remove her underwear, she responded, “no one gets on my flight unless I say so.”

The reality is that such mini-dictators, the peons of bureaucracy, are nearly replete of any actual authority. Frustrated by their inability to control their destiny, they act out their near total lack of authority by overcompensating within the one slice of power they have – in this case, the power to drive a woman close to tears because her suitcase had to be pushed into the measuring device instead of sliding right in.

You’ve run into these people. They’re at the DMV and the post office and the TSA.

And, they’re at hospitals: The petty midlevel “executives” who occupy places on an org chart that looks like IBM’s in the 1960’s or a plate of spaghetti. They are the bureaucrats who can say “no,” but who lack any authority to actually say “yes.”

Lord Acton commented that power tends to corrupt, and absolute power corrupts absolutely. It appears that the lack of actual power does the same.

The quill required to effectively deal with these people includes multiple arrows. Some are polite, others are political, and more than a few are pointed. An effective strategy involves knowing when and how to get the petty bureaucrat to open the gate, when and how to get around him, and when and how to get him pushed out.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

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State Licensing and Anti-Competitive Bureaucracy

At a time when telemedicine and telehealth are poised for rapid expansion, many state medical boards are doubling down on what appears to be their true purpose: enacting and enforcing anti-competitive measures to protect those already licensed in the jurisdiction.

Medical boards, like all professional licensing boards, are bureaucratic barriers to open competition. Sure, they justify their existence as protection of the public, but laws governing consumer protection don’t necessarily require state licensure as opposed to state registration as opposed to the even lesser deemed submission to state discipline.

The problem with bureaucracies is that once created, they never want to destroy themselves. Somehow, protecting the jobs, and the power, of petty politicians outweighs the harm they cause to society. Yes, the harm they cause by way of higher prices and a restricted supply of regulated professionals.

In the end, because the force of the future can’t be stopped, that protection simply means that those within the protected class will be disrupted from outside of it as opposed to from within.

Take a look, for instance, at what is going on in states like California. While the medical board is going about its job of protecting in-state physicians, the rest of the bureaucracy wakes up to the fact that there is a physician shortage. Instead of the obvious solution, which is fast tracking the ability to practice across state lines, the end result is the creation of other classes of licensed professionals such as naturopathic physicians and the expansion of the scope of practice of existing nonphysician healthcare providers.

It’s time to stop the B.S. of medical boards, state bars, and other relics of the past and to acknowledge what they are: Officially endorsed engines of anticompetitive behavior.

I’m not saying that we need to do away with consumer protection. I’m not saying that we need to do away with disciplining bad professionals. I am saying that we need to put those police powers in a “box” by themselves and drop the rest of the shenanigans that no longer pass the laugh test.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

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