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It’s a Good Day
It’s that magical time of year again: time for the annual SRA (Security Risk Assessment)!!! Medical offices across this great land look forward to this all year long. As you no doubt are aware, the SRA was developed by the ONC in collaboration with HHS OCR, and is required by CMS to be sure that your EMR complies with HIPAA. It is far too complex to be understood by mere doctors, so I pay a consulting firm to submit the proper regulatory paperwork to the proper TLA’s (Three Letter Acronyms) on my behalf. A cynic might think that it’s not that it’s complex, but rather that it was designed to require third party consultants, to help the government control healthcare. But that would be very, very cynical. So never mind.
As I was filling out another form, answering questions that I do not know the answer to, for the consulting firm that audits the consulting firm which administrates my EMR and is currently being audited by SRA from HHS OCR, I was reminded of ductwork. What does ductwork have to do with medical charts, you wonder? They are both heavily regulated by the government. So they have a lot in common. This was explained to me by a government inspector some years ago, in Tennessee:
I was building a new office, and so I had a steady stream of contractors, and a steady stream of inspectors, coming in and out of the building that was starting to take shape. My general contractor recommended a certain HVAC installer. I knew him (this was a small town), and I knew that he was a notorious drunk. I asked why he wanted that guy to install my heating and air system.
My general contractor explained that the drunk HVAC guy’s cousin was the inspector for HVAC. The advantage was that his stuff got approved with less hassle and fewer fines than most other contractors. The disadvantage was that he was always drunk, so there were more mistakes and problems to fix after he left, but nothing that can’t be fixed later, he explained.
Sounds great, I said.
What else could I say?
Once the heat pumps were installed, the inspector showed up. He seemed like a nice enough guy. He used to install HVAC himself, before taking a job with the government. After talking about family with the HVAC contractor (one of their cousins had just gotten nailed for his sixth DUI), he walked around for a while, looking at stuff. He pointed to something and said something like, “The regulations say you can’t do that. But there’s another reg that says you can. So we’ll leave it.” He was trying to be nice, obviously. But I was curious.
I asked, “Why are there so many rules? Even you don’t know them all, and many of them conflict with each other, like the one you just cited. If they’re so complex that it’s impossible to follow all of them, then why do we have them?”
He laughed and said, “Yeah, I know. It sounds strange, right? But there’s a good reason for it. The old guy I took over for explained it to me like this. There are regulations against just about anything you could possibly do. So if an inspector walks into a site and just feels that something’s not right; you know, it just seems wrong, or the general contractor’s a jerk, or whatever… you know, you’ve got a bad feeling about the whole thing well, then, you can find some kind of reg to use to shut it down. If the rules were too simple and straightforward, it would really limit the ability of inspectors to use their own judgment.”
I instantly realized how important it was that I should be really nice to this guy, so I spent the rest of his visit talking about hunting and fishing. He finished his paperwork, left with a friendly smile, and my general contractor got to work fixing all the stuff the HVAC installer had screwed up because he was drunk.
My general contractor, I’ll never forget, smiled, and said, “It’s a good day.”
My SRA from HHS OCR to ensure that my EMR complies with HIPAA is the same thing. There’s really no way to follow all their rules. I don’t even know what they are. But that’s not the point.
The point is that my betters can determine who is permitted to do what, based on their own judgment. If the rules were simple and straightforward, it would limit the ability of the government to control its citizens.
This is why our Constitution was designed to control our government. Because, unrestrained, any government will gradually gain complete control of its citizens.
As my HVAC inspector cheerfully explained, it sounds strange, but there’s a good reason for it.
I think most of my answers for my SRA are largely correct.
It’s a good day.
Published in General
I don’t know how R. articles find their way into other conservative websites.
But if anyone is reading this and has some influence: I think this deserves a wider audience.
This notion of making things less complicated is the number one reason income tax simplification will never happen.
The entire lucrative industry of tax preparers, CPA’s, and tax attorneys would be devastated.
Do you really want to take food out of the mouth of the poor CPA?
This would be a lovely short essay on NRO. Frankly it’s magazine quality.
So the way we’ve always suspected this stuff works turns out to be true!
This should be the lead editorial for the Wall Street Journal.
Bravo. :-)
Not even the president of the United States can escape this madness.
They have ways of punishing people who produce this kind of information.
I can answer @markcamp’s question about how articles like this one get a wider audience. Bloggers like me (I blog at RushBabe49.com) reblog their articles on public-facing blogs. With the good doctor’s permission I can post his article as a guest writer, and I can change any identifiable characteristics to protect his privacy. I have done it before. @drbastiat?
The laws are complicated so that they can be selectively enforced. Three felonies a day, remember?
Anyone who has ever built a house or started a business doesn’t suspect it he knows for sure.
This is the direct and unavoidable consequence of the administrative state, not a bug but a feature for those in charge. Presidents Wilson, Roosevelt and Johnson began and expanded this to take control from us plebes and give it to experts. Trump was elected to roll this back but has been largely stymied. It took a depression to get people to accept this in the 1930s. What might it take to overturn it?
Go right ahead. Thanks!
Liz Warren tells me the medical industry will be vastly more efficient, when the government takes over as the sole “insurer”. That got me to thinking that problem is really over regulation. Local laws on top of state laws on top of federal laws and insurance rules and AMA rules really adds up, but I think the regulations are so spread out that no entity can deregulate to create efficiency. I don’t see any path towards a market solution.
Does anyone else think Liz is putting a 100% tax on the tax free health care income from employers.
Yes.
I once asked a partner at the accounting firm where I work why the tax code was so complicated. “Is it just because the world is complicated? Because life is complicated? Or is it just because Congress makes it that way?”
He said, “Because Congress makes it that way.”
This is from Arthur M. Diamond, Jr., Openness to Creative Destruction: Sustaining Innovative Dynamism, forthcoming in 2019 from Oxford University Press.
This reminded me of a story with pretty much the opposite take on contractor / inspector relations. As a yut, I was working construction on a large house. Veeeery late one afternoon, an Inspector was dragging himself up the path, looking disheveled and exhausted. Now, as it happened, the plumbing work on the project had been done by The. Best. in the county. As he passed us, he looked up and said “Anybody know who did the plumbing work on this place.” We told him. His eyes got big. “Really?” A smile crossed his face, and he walked over and tied the “Passed” tag to the permit box. His immediate departure seemed much more relaxed and enthusiastic than his arrival.
His inspection was just as helpful as mine was.
Doc, the Lovely and Talented Mrs. Mongo is a clinical risk manager (and an RN with about 137 years’ experience; aka Super Nurse). She’s awesome at it and is doing exactly what she was put on this earth to do.
Ofttimes, when she downloads her day and I ask what seems a common-sense question, she rolls her eyes. It’s not a dismissive, “that’s such a dumb question” eye roll. It’s a “I can’t even find a start point for a conversation about common-sense questions” eye roll. So, I kinda/sorta feel your pain.
Endeavor to persevere, Doc.