Imagine a system in which people chose what products and services they valued, and the people who provided them determined what made it worthwhile to provide the service.  Then, under mutually agreeable terms, the customer could use some sort of measure of value (represented by money) to compensate the provider.

That’s the question that came to mind when I read Bill Rappleye’s WJAR story about confusion in the area of home health care workers, thanks to a new system:

“We really want the providers to know, and we’ve told them, that we will continue to keep the old system in place, so that if it hasn’t worked yet, for them, because this is about coordination from both sides, then we will continue to accept records on the old system,” Roberts said. “Claims and validations, on the old system.”

[Director of the Rhode Island Partnership for Home Care Nicholas] Oliver said that’s news to him. He’s meeting with Roberts on May 20. He said if he can’t get the deadline for switching to the EVV system changed to September, he will try to get the General Assembly to act, and if that fails, he may seek a legal injunction to try and straighten out the training and implementation process, before the system is introduced.

This isn’t a matter about which I’ve heard much, elsewhere, so I can’t say whether the new system is better or worse, or what’s driving its implementation.  It’s the whole exercise that gets my mind spinning.

The payment stream for this particular type of work has been consolidated to such a degree with government that it’s become worthwhile for the providers to pool money to fund a lobbyist.  The state implements a change about which the providers are unsure, and the next thing you know, we’ve got sympathetic stories raising vague anxieties and the potential for changes to state law, which would become more chips for political horse trading and yet another issue preventing voters from making straightforward decisions about elected representatives in order to ensure the sort of government that they want.

Now multiply this by everything that the state government does. No wonder government becomes ever-more expensive and people are becoming cynical about the degree to which it actually represents anybody but inside interests.