"Look how shitty government is, elect me to fix it"
Who, exactly, are you referring to?
It's not like the stuff the article covers started in January of 2017. Who, exactly, in the chain of command here "hates government"?
The state government is controlled by Republicans and though not all Republicans "hate" every aspect of the government, a large contingent of party could be accurately described as hating government involvement in areas they don't agree with--like welfare, disability, healthcare etc...
The leader of the party has explicitly advocated for allowing and encouraging the current healthcare system (the ACA) to implode, so that he can replace it with something else. He also placed people in charge of departments who explicitly stated that such departments shouldn't exist.
In 2019, we are living in a world where one of the two parties made bad government a cornerstone of their party's policy, ~35 years ago. We are now reaping the wages of that decision.
The guy who's shooting dogs for the ATF might thing the DEA is scum and the guy who's shooting dogs for the DEA might think the ATF is a waste but they both believe in the mission of their organization (or at least to the extent needed to do their jobs). They don't care or even realize that shooting dogs isn't their mission, it's just what the incentive structure tells them to do.
These doctors are shooting all the dogs (metaphorically speaking of course) but they're shooting all the dogs because the organization they work within has incentivized that behavior. It's not a top down policy to shoot (metaphorical) dogs. It just so happens that if your top down policy is to suck at everything then there's no motivation to stop the people at the leafs of the organizational tree from shooting dogs (denying disability wrongly as a matter of standard) practice. I think this is incompetence, not malice. The people actually misbehaving are too far removed from policy for this to be malice.
It's curious that you can see how incentives shape the behavior of some people, but not that of other people.
It’s not about people at the top responding differently it’s about the flow of influence. If 20% of the people at the bottom behave poorly the other people at the bottom have little influence. That changes at the top as it’s easyer to monitor a small group of people and their actions are more documented.
Ex: A cashier can fail to scan items for their friends at checkout and without any form of paper trail. The CFO can do more harm, but it’s harder for them to act in secret.
That's simply not true. Go to DC and you will meet a lot of dedicated and highly qualified people working at agencies. And they stay around. The real problem is Congress and some of the media that just scream "government bad" and "deep state" instead of doing their job which is to give the agencies guidance and fixing problems.
Some organizations are looking for a paper trail to indicate they've done something - anything - to remedy the issue. Others try to get the full story and fix the rot.
I think we just don't hear about situations where the whistleblowers do a tremendous amount of good, because those are situations in which the problem has successfully been contained and thus aren't newsworthy.
Where is the corporate lobbying in this case? There are no corporations mentioned in connection with this story.
There is almost certainly a prime contractor who owns the relationship, who then hires independent contractors as subs. They probably collect a percentage or fixed fee for each piecework task completed.
"Like Thrush, some of these doctors work very fast.
Dr. Kanika Chaudhuri, a pediatrician, evaluated 3,872 cases last fiscal year, averaging more than four cases per hour when she worked. She earned $192,000 in fiscal 2018 and $1.1 million since 2013.
Out of all the cases Chaudhuri reviewed over the five years, 78 percent were denied, according to data provided by the state."
Is it really a safe assumption that all states have identical rates of fraud? Different states have very different economic and social situations that could pressure somebody into committing fraud. Some states are suffering more than others with prescription drug abuse. Some states have industries that result in more disabilities than other states \cough{coal mines...}
In West Virginia 8.9% of the working age population receives disability, while in Hawaii only 2.8% do. In Tennessee, 6.5% of the working age population is on disability. The national average is 4.6%
"Staff doctors take more time. The state employed a small number of staff doctors whose compensation is not tied to the number of cases they review. These doctors reviewed cases at a rate that is in line with federal recommendations. They typically earned less than $150,000 annually, according to the state’s salary database. Beginning this year, however, the state is terminating all doctors on salary and relying only on contract physicians."
So essentially, salaried state doctors took their time to review cases, perhaps realizing that these are real people on the other end of the paper work. The state doctors were paid less than the private doctors and the state is going to lay them off to go full private despite the fact that some of the private doctors are clearly just plowing through the reviews to boost their income.
A whistle blower then called this out and was let go.
Seems like corporate lobbying is alive and well in TN. Don't worry about the individuals, there's money to be made.