After reading her column, I sent her the following email:
My husband and I spent a year in New Zealand where he worked at Lakes District Hospital in Rotorua. As an otolaryngologist (ENT), he took on the surgical waiting list (over 100 surgeries) and the back logged appointments (referrals dated a year prior) enthusiastically. He suggested that if the hospital hired one more surgical tech, and ran three OR's at one time, he would be able to have the surgical wait list to -0- in a month. He was taken aside, and subtly but to the point, asked to cool his American-styled jets. He would be there only a year, but they had to continue working in the same system. He was informed that should they operate with the efficiency he suggested, their budget the following year would be the same but the level of production would be expected to also be maintained, and if not, then their budget would be cut the year after that. They were very happy with the status quo, as it was a very pleasant, 9 - 5 type of operation. None of this American, higher productivity and efficiency for them! They were very fine with a lower level of stress, thank you very much.
Needless to say, we readily embraced the New Zealand life-style. When we left New Zealand, there were 110 surgeries on the wait list. I'm not sure Americans are ready for this type of system, one where wait lists are common and doctors are not readily available, which is exactly what the 'global payment' structure is modeling. As is usually the case, what seems like it would work on paper, is another thing altogether in real life. But what is big bureaucracy, if it's not a lot of paper pushing? And if nothing else, we are certainly heading toward a bigger bureaucratic nightmare than we've ever experienced in the past