Gov McCrory’s tired “silos” metaphor makes little sense for NC Medicaid

silo “The system is working in silos, and the silos are not communicating,” McCrory said. “We want a coordinated system of providers.”

“[NC Medicaid Community Care] lacks a culture of customer service and operates in silos, making it difficult for recipients to know where to go to receive the right care”

Governor McCrory obviously isn’t too familiar with his own Medicaid system in his own state where every patient in NC Community Care has the name and phone number of their family doctor printed on their Medicaid card.  In addition, NC Medicaid’s Community Care program coordinates providers from hospitals to family practices statewide in fourteen well-defined community networks.  This system has saved so much money and improved health care so drastically that NC’s conservative US Senator Richard Burr just gave NC Medicaid Community Care yet another national award just last week.

So the Governor is clearly misinformed about NC Medicaid but, even so, why all the focus on “silos”?  Like most North Carolinians I’ve seen many a graceful grain silo on our beautiful country roads.  I guess he’s trying to imply that we North Carolinians don’t work together enough with this metaphor, although why selling off our award-winning Medicaid system to a bunch of out-of-state Wall Street companies is going to fix us up by putting all our “silos” together is really a head-scratcher.

Actually, it turns out that McCrory uses this “silos” metaphor so much that the fact it came up in the Medicaid program shouldn’t be a surprise.  Silos pop up so frequently that you’d think Governor was born on a farm instead of in Columbus, Ohio.  For example:

On the state budget:   “I’m going to have to move spending within the silos, McCrory said, “and move it to areas where there’s greater need and take it from areas that have less need.”

On vocational training:   “which is very close to my heart,” to determine “how can we tie in those silos in a better way.”

On education in general:  “The K through 12 silo, the community college silo and the university silo.”

On the UNC budget:  “We’re doing the budget in these silos instead of looking at the big picture,” he said, at a Board of Governors meeting at UNC Pembroke.

On government in general:  For far too long, our state’s departments and agencies have operated in silos, often ignoring the needs of the very people we serve and creating inefficiencies with your tax dollars.

The “silos” talking point is repetitive and it’s not very effective, especially describing how we organize health care under our Medicaid program in North Carolina.  Our providers and communities work together more closely than in most other states in the nation to deliver efficient and effective care.  The Governor would do better to learn more about his own excellent Medicaid program and leave the “silos” alone to define our rural North Carolina heritage.


  1. Doug

    April 15, 2013 at 4:52 pm

    If you have never worked in a large business you may not know what the metaphor means. When you have divisions or entities working in silos there are huge numbers of inefficiencies taking place. There is duplication of efforts, poor information sharing, and general waste. I do not really expect this blog to understand streamlining of operations as that is the antithesis of leftists since it would increase efficiency, cut costs, and provide a better product. You guys only understand government increasing costs, creating a poor product, and limiting supply in step with the communist/socialist model.

  2. Rip

    April 15, 2013 at 4:58 pm

    At least we work above ground…can’t say that for the Neanderthals of the Right…You guys only understand worshiping the wealthy…

  3. Gene Bridges

    April 15, 2013 at 5:08 pm

    Au Contrare, Doug, Medicaid is, in reality – with hard evidence to support it in NC – a very efficient, well run system. Community Care is not known for poor information sharing, etc. Where there is poor information sharing is at DHHS itself – and that’s an IT infrastructure problem. DHHS *does* function in “silos,” and anybody who has ever worked with DHHS knows that is so. There are some offices that don’t have functioning email systems. DHHS and Community Care are not convertible offices.

    But that’s not the case with Community Care and the associated providers. Thanks to Governor Purdue, we even have a nifty computer program that was installed last year to track billing and other information from providers and we’ve located a whole lot of fraud that way.

    Farming out Medicaid to private companies (notice the plural) by the same logic you offer (seriously, our expectations of rudimentary logic for you are so very low), would (by your own logic) be the very definition of silos – each provider and each coordinating entity working with different systems. Yes, that’s very efficient.

    Doug writes: I do not really expect this blog to understand streamlining of operations as that is the antithesis of leftists since it would increase efficiency, cut costs, and provide a better product.

    We shouldn’t expect Doug understand anything about Medicaid. He doesn’t like it as it is, so he’s all for speaking against it. It is the antithesis of the Tea Party mind to do anything but offer a bunch of libertarian platitudes. All Doug has are some Tea Party adjectives that he substitutes for hard data. Reality Check: NC is trying to emulate Arizona. Arizona has farmed out Medicaid to private employers. Arizona, *by the admission of our own state’s Medicaid Director* is guilty of a great deal of duplication of efforts, poor information sharing, and general waste. Their costs, when those entities are taken into account is about 3 times as high as ours right now – exactly the opposite of what the Governor has claimed he actually wants.

    Where is your argument that NC would fare any better? All you have offered so far are platitudes and adjectives. When the chips are down, all Doug has to offer us are accusations of communism. All Mr. McCrory has to offer is a bunch of fact free metaphors and assertions. That’s because neither one actually knows what he’s talking about.

  4. Bad Pharma

    April 15, 2013 at 5:48 pm

    isnt NC Medicaid spending more than a billion dollars on pills, that may or may not work, many of which have major side effects? Why isnt more post marketing surveillance being done to see if taxpayers are getting their money’s worth? Time to step up the pharmaco-vigalence, follow the money offshore and name names about who the profiteers are.

  5. gregflynn

    April 15, 2013 at 5:52 pm

    In Doug’s defense, he does also offer pejoratives.

  6. Chris

    April 15, 2013 at 9:13 pm

    “I do not really expect this blog to understand streamlining of operations as that is the antithesis of leftists since it would increase efficiency, cut costs, and provide a better product.”

    How is adding a profit-seeking new level of bureaucracy to the system going to “increase efficiency, cut costs, and provide a better product”? The product is supplied by the doctors and pharmacies— anything else standing between the patients and the doctor is just a leech, and I prefer a public option driven by minimizing waste than the broken model driven by profit.

  7. Jack

    April 16, 2013 at 9:15 am

    Doug, when you say “provide a better product” are to referring to Enron and the derivatives produced by Wall Street, that kind of better product?

  8. Doug

    April 16, 2013 at 11:06 am

    You say profit, I say take the government corruption. I dare say that when a company gets it’s hands on the efficiency models of our Medicaid system there will be plenty of opportunities for profit. For example the government having 3-4-5-6 departments that all do the same thing coming down to 1 would be an example. You replace the government bloat and corruption, and you get the profit.

    Enron got what they deserved for doing it wrong, I seem to remember Enron going bankrupt. Government however would have bailed itself out, paid off it’s cronies, kept the same program going on higher costs forever since government never shrinks, and made taxpayers pay for it. But government does try to choose winners like Soylindra (sp?)….which directly cost taxpayers what $500,000,000? Now that is your “better government product” LOL.

  9. Chris

    April 16, 2013 at 11:53 am

    You wish to replace the fixable “government bloat and corruption” with untouchable corporate bloat and corruption. Taxpayers have the capacity to reform the government, but nothing can be done to fix corporations. It’s been how many years and Wall Street remains unreformed? CEO pay is egregious compared to what passes for a sub-poverty level minimum wage. Your argument is nothing more than wishful thinking with absolutely no analogous real world application to prove it will be done, much less than it can be done. There is proof that private corporate leeches that stand in the way of the patient from medical care (like the entire broken health care system we have now) should be avoided at all costs. It should be single-payer for all.

  10. Doug

    April 16, 2013 at 3:09 pm

    Nothing about the government bloat and corruption is fixable. That is historically evident for at least as long as I have been alive of our government which has done the opposite, it has continued to get increasingly bloated, corrupt, and meddlesome. What happens with corporations that are bloated, corrupt, or obsolete? They have to change and get more efficient or go out of business. Think of Jack’s Enron, where are they now? How about Kodak and Polaroid, they had to adapt and get better. What about General Motors and Chrysler, poster boys for bloat and inefficiencies…..oh right the government kept them afloat to continue to produce (pirmarily) poorly executed cars….guess that proves my point. The government just serves to mis-allocate resources where the market would work. How about too big to fail banks? The government steps in, guarantees high salaries for executives, while preserving poorly run companies that now know they are propped up by the government and will not be subject to market forces.

    It is still the same story let the market work, otherwise you have the government involved in a low quality product, that costs more, and you get less of it….not that in some cases you want any of it since it is probably mis-allocated anyway.

  11. Chris

    April 16, 2013 at 5:49 pm

    Both the automobile industry AND the banking industry are rather ex post facto examples that ignore the fact that they failed on their own BEFORE government meddling. The failing state of the economy at the time did not need additional burdens to put more people out of work because the market is not the inherent good as you seem to fantasize. It is also worth pointing out that President Bush and the Republican Party was largely responsible for both of your criticisms, and so now I chuckle at how really your problem isn’t with government, but the Republican Party which is, as we’ve discussed before with regards to how broken and hated Congress is, feckless as can be (see also Governor McCrory in the article above for a current example on a state level of Republican fail).

  12. Doug

    April 17, 2013 at 11:00 am

    You miss the piont. One more instance of government mis-allocating resources to prop up a failing business. If the market had been allowed to work at the time, we would not be in the mess we are in. And yes…..I can criticize Republicans too, I have issues with many things Bush did….heck Barry has expanded on them. I see both parties as detestable to some degree because they promote government too much, so yes it is the government that I am targeting. But the democrat party gets teh most ire because they are originally the party of big government and socialistic spending and massive failure. The Republicans have just eased themselves on board to a lesser degree….so they are the lesser of two evils.

  13. Chris

    April 17, 2013 at 11:39 am

    Hardly the lesser of two evils just because they are more incompetent at government and cater to the untouchable evils that drive the market over the cliff, Doug.

  14. Doug

    April 18, 2013 at 2:11 pm

    Wrong there Chris, governement is the evil so the one party that will at least pay lip service to smaller government is the one to go with. Rather that “running the governemnt” we need to be disassembling the government in areas where it does not belong.

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