Among my many musical areas of interest is punk rock, as performed by the original creators between 1976 and roughly 1984. If music was ever in need of someone stepping to the fore with an airing of grievances, it needed to happen in the middle of the self-indulgent, fashion elitism of the disco era.
One of the founding principles of the punk rock movement was the idea of skipping revolution and going straight to anarchy. In the post-Watergate era in America, and as the post-World War II excesses of the upper economic echelons continued in Great Britain, the idea of being completely leaderless held a certain appeal for many, including me. That personal fascination ended abruptly in 1994, when the events in Rwanda showed the world in stark terms what anarchy actually looks like. Nations, organizations and institutions need stable leaders and a cultural direction, mainly because to leave the human race to their own devices invites the worst of all possible scenarios.
It was with this philosophy in mind that I came across a story this week regarding Marilyn Tavenner, the current Acting Director of CMS. Due to archaic procedural rules in the U. S. Senate (seemingly designed to insure gridlock), it was announced that there would be no confirmation hearings to remove the “Acting” portion from her title. As a reminder, based mostly on political pie fights, CMS has had only acting directors since 2006. Ms. Tavenner is the 5th such temporary director in that time period.
CMS is now deeply submerged in multiple initiatives designed to transform the government health benefit payment model from one of consumption to one based on the quality of the outcomes. Most of these initiatives have come into being with the agency lacking long-term leadership. It has indeed been a difficult task to bring forth such things as ACOs, increased audit initiatives, mandatory medical records and ICD-10 when the average tenure length of leadership at CMS over the past 12 years is one year and 73 days. Looking at that number, it reminds one more of the random length of a prison sentence rather than a legitimate term of leadership.
As the story linked above clearly demonstrates, Ms. Tavenner does not appear to be as polarizing a figure as her predecessor. She has admirers on both sides of the aisle, which is admirable given the rhetorical gulf between the two sides in Congress. On the surface, there is no logical reason why her installation as a “permanent” agency head should be postponed. Given that based on averages, Ms. Tavenner is more than likely just about half way through her term as acting director, the nonsensical nature of the delay is compounded.
By their inaction towards the needs of CMS and the people who rely on the Medicare and Medicaid programs running smoothly, the Senate is giving us another window into the world of anarchy, albeit a less violent example than the streets of Rwanda in 1994. As announcement e-mails from CMS regarding new initiatives slowly fill my inbox, I head into the long holiday weekend wondering who or what will run CMS the next time the Anarchy Train comes to town. As a pointedly-named punk band of yesteryear once put it, “It’s coming some time, maybe”.