I should really let you all know that I'm in a much better state, getting regular physical therapy and recovering well, though I've got a long way to go. My grievance with the hospital now boils down to just one item, their catastrophic inability to communicate, which I guess is a form of the "administrative burden" Brad DeLong was writing about (the day after my accident, as it happens) :
Pamela Herd & al.: Administrative burden as a mechanism of inequality: ‘Ask anyone about their interactions with government, and chances are you will get an earful about a seemingly Kafka-esque experience that they or a family member has faced trying to access vitally important social rights such as health care, income support, unemployment, and food assistance, or a fundamental political right….
Administrative burdens have the odd combination of being both grindingly familiar to us as individuals, and largely unattended as a matter of policy analysis, design, and practice…. One explanation for this failing is the fragmented discourse around them, siloed both across and within academic disciplines and policy areas…
The hospital never in fact abandoned me, they just never let me know. I wasn't getting PT right away because I wasn't expected to be ready for it until considerably later (most patients are too broken to start exercising for at least a couple of weeks; I was ready, in fact, as they could have found out if they'd been paying attention, but they were treating a fictionally average patient). There's a whole series of follow-up visits going on into October I have to attend, but they didn't tell me in advance, just started scheduling them and calling me when that was done. All the medical personnel are very nice, encouraging, and happy to tell me what they know (which is of course limited by the "team" approach; I finally had an appointment this morning with the "Dr. John Muller" who undislocated my finger but never entered my brain, but he still didn't show up—it was an extremely pleasant young woman called "Dr. Miller" that examined me and sent me on my way).
It is, as DeLong's reading suggests, a form of the enforcement of inequality. We commonly think of administrative burden as a rightwing issue, complaints about excessive regulation, and the suffering of businessmen forced to furnish proof that they're not robbing the public or endangering their workers, but it falls more on the disadvantaged, who can't hire the assistance they need to emerge from the process successfully and experience it not as too much paperwork but as sheer neglect:
My view is that administrative burdens do not vary much across different types of interactions with the government—but that means that you are f***ed if you cannot afford to buy expertise to figure out how to minimize the burdens, or if you find yourself in a place in your life where you have to have a lot of interactions with a lot of different arms of governments. And federalism is an absolute killer.
Thus it is not a mechanism that raises inequality so much as a burden that existing inequality makes much heavier on the poor than on the rich—that insulating themselves from government-imposed administrative burdens is another one of the things the rich can and do buy with their money.
Something I've been too prosperous to experience in recent years (not entirely: I've had some bad and mystifying tax issues connected with Social Security) but remember from my youth and bouts with unemployment insurance and food stamps (back when there were actual stamps) and student loans, in pathetically small amounts (low four figures), that somehow took me decades to pay.
Now I'm past the actual horror I wrote about a weekend ago, I'm taking it as an opportunity to think about these matters, and kind of glad of the experience.
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