Someone should rate Senators and Representatives on the quality of their constituent service. When someone writes a Representative for help with a government agency, he or she should get a poll a few months later, asking how receptive and how effective the staff in the Representative's office was with the problem. Consumer Reports rates cars and washing machines. US News and Washington Monthly rate colleges. Some magazine or organization ought to rate Representatives. Imagine a magazine cover splashed with:
"How well does your Representative in Congress serve YOU?
Ratings on all 435! Is yours one of the top-rated, or at the bottom?"
An exchange of comments with dinotrac motivated me to write this up. You can find the comments here:
http://www.dailykos.com/...
Some people, even ones who post here, seem timid about asking their Congresscritter for help. Hell, I think that's what we're paying them for. We should dump any complaint we can in their laps.
As a lifelong complainer, I've had ample opportunity to learn what kind of complaining works, and what doesn't. Occasionally I've taken advantage of that opportunity and actually learned something. One of the clearest lessons is that when dealing with the Federal government, the person to complain to is your Congressman or Congresswoman. I'm hardly the first person to say that, and my learning it was prompted by reading it in a book somebody else wrote, but I can suggest reasons it's true, and give examples of how using your Congressperson as an "ombudsman" has worked for me and for my patients.
There's nothing in the Constitution to suggest that our representatives in the House should serve as troubleshooters for their constituents. The Founding Fathers probably thought of serving in the House of Representatives as a part time job. They probably didn't envision that Congress would eventually be in session most of the year, or that Representatives and Senators would have offices in Washington and in their home districts or states to deliver constituent services. But that's how it has worked out, and sometimes it's an effective system. I've seen it work.
The bottom line is that when a Federal agency gets a Congressional inquiry, it seems the first thing that happens is that people at the agency soil their underwear. Then they ask how high they need to jump. Then they try to jump twice as high. Below the dotted line is a long, but possibly amusing, story about how I came to that conclusion.
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Back in the 1970's I did part of my residency training at a VA hospital. One day I was in Triage, the VA equivalent of an emergency room, when someone brought me a patient's chart and a message. The message was that this patient was coming in, and I should just sign something to admit him to the urology service and send him straight on up to their floor. Urology had agreed to accept him. This was odd. Usually the triage doctor was there to decide whether or not people needed to be admitted. So I thumbed through the man's chart and asked a few questions relating to the special treatment. One of the clerks who'd brought me the chart and message said something like, "Oh, this man's chart lives on Mr. [assistant administrator's] desk."
I held up his medical record and asked, "What, this chart?"
"Oh, not that chart. His administrative chart." The clerk went on to explain that every patient had an administrative chart, separate from the medical chart. For most veterans the administrative chart had about three pages -- something showing that the person had an honorable discharge from the military, and probably information on how to contact next of kin. But this man's administrative chart was half an inch thick. I asked if I could see it. She said sure, and fetched it for me.
A bit of background: The poor patient had been discharged and sent home after a war ended, World War II, I think. A few weeks later he'd developed meningitis, which left him brain damaged, bed bound, and needing a lot of nursing care. Somehow his wife convinced the Veteran's Administration the illness and all the sequelae were "service connected", so he had a 100% service-connected disability. (He was clearly 100% disabled, but saying it was service-connected seemed a stretch. I suppose it's not impossible, though, that the patient got his throat colonized with meningococcus in a crowded troopship on the way home, and a few weeks later those germs gave him meningitis.) Anyway, the wife took care of him at home, at least partly, but she frequently wanted him admitted to the hospital. She could well have needed a break. For hospice patients at home, such an admission is now called "respite care" but back then hospice was a very new idea and I doubt anyone had thought of respite care.
Anyway, the wife knew the system pretty well. As I thumbed through the administrative chart, I found copies of letter after letter she'd sent to various people in Congress. I remember a letter to Senator John Tower, complaining in rather insulting terms about the care the VA was or wasn't providing her husband, with some insulting comments about Mr. [assistant administrator]. Senator Tower's office had simply forwarded the letter to the VA hospital administration with a bland, polite cover letter asking them to please check if the patient was eligible for any further VA benefits. Guess what: Each pair of letters like that was enough to get the man admitted to the VA hospital for a week or more. The senator's office didn't even need to ask for any special treatment for the administrators to, in effect, ask how high they needed to jump and then try to jump higher. Of course, it wasn't that much skin off the administrators' noses; the doctors in residence training were the ones who'd have to do most of the jumping and dealing with the demanding wife. (I was lucky enough never to meet her myself. The situation certainly hadn't made her easy to deal with, if the letters she wrote were any indication.)
In this patient's case, complaining to Congress worked very well even though several things may not have been done in the most effective way. I have the impression that a polite letter works better than an angry one. Also, I've seen better results going to Congressmen or Congresswomen than to Senators. On the other hand, in this case there was almost no pressure on the other side: At the time, there was little budget pressure on the VA system, and no pressure group has ever lobbied to reduce veterans' benefits.
In practice, I've found that complaining to a patient's Congressman can get good results if Medicare is being unreasonable. Several times, I've written letters that start out, "Ms. So-and-so, your constituent, is my patient and she's having trouble with Medicare." That worked very well with the previous Congressman who represented the district where most of my patients live, and with his predecessor. But I'm not sure the staff of the current Congressman for that district is going to do as well. That gave me an idea. Someone should rate Senators and Representatives on the quality of their constituent service. When someone writes a Representative for help with a government agency, he or she should get a poll a few months later, asking how receptive and how effective the staff in the Representative's office was with the problem. Consumer Reports rates cars and washing machines. The car reliability ratings are from polls of their readers. US News and Washington Monthly rate colleges. Some magazine or organization ought to rate Representatives. Imagine a magazine cover splashed with:
"How well does your Representative in Congress serve YOU?
Ratings on all 435! Is yours one of the top-rated, or at the bottom?"
The polling could and should be done in a non-partisan manner. But I wonder if the Representatives who that think government can't do anything right would rate poorly. It makes sense; if you think government can't ever get it right, why try?