War on coronavirus also a war on paperwork
As part of the war on coronavirus, U.S. regulators are taking aggressive steps against “sludge” — paperwork burdens and bureaucratic obstacles. This new battle front is aimed at eliminating frictions, or administrative barriers, that have been badly hurting doctors, nurses, hospitals, patients and beneficiaries of essential public and private programs.
Increasingly used in behavioral science, the term sludge refers to everything from form-filling requirements to time spent waiting in line to rules mandating in-person interviews imposed by both private and public sectors. Sometimes those burdens are justified — as, for example, when the Social Security Administration takes steps to ensure that those who receive benefits actually qualify for them. But far too often, sludge is imposed with little thought about its potentially devastating impact.
The coronavirus pandemic is concentrating the bureaucratic mind — and leading to impressive and brisk reforms. Consider a few examples.
Under the Supplemental Nutrition Assistance Program (formerly known as food stamps), would-be beneficiaries have had to complete interviews before they are approved for benefits. In late March, the Department of Agriculture waived that requirement — and now gives states “blanket approval” to give out benefits to people who are entitled to them.
Early last week, the Internal Revenue Service announced that in order to qualify for payments under the Families First Coronavirus Response Act, people would have to file tax returns — even if they are Social Security recipients who typically don’t do that. The sludge would have ensured that many people never got money to which they were legally entitled. Under public pressure, the Department of Treasury reversed course — and said that Social Security recipients would receive the money automatically.
Some of the most aggressive sludge reduction efforts have come from the Department of Health and Human Services. Paperwork, reporting and auditing requirements are being eliminated. Importantly, dozens of medical services can now be provided through “telehealth.”
In the department’s own words, the government “is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.”
In addition, Medicare will now pay laboratory technicians to travel to people’s homes to collect specimens for testing — thus eliminating the need for people to travel to health care facilities for tests (and risk exposure to themselves or others). There are many other examples.
The Food and Drug Administration has granted greater flexibility in several domains. For example, it has allowed the New York State Department of Health to allow patient testing in circumstances in which formal authorization by the FDA (and accompanying sludge) would previously have been required.
One reason for the current war on sludge is a new cost-benefit calculus: When countless people are getting sick or poor, the harmful effects of administrative burdens grow exponentially. In normal times, it might be acceptable or sensible to tolerate a delay, to protect against some kind of social harm or to require people to do some work to prove that they really do qualify for benefits. But we should be willing to accept less than perfect accuracy, or less than ideal safeguards, if that is the price for saving lives.
Another reason for the war on sludge is subtler — and even more fundamental.
Many people are now scared, confused or anxious about their health or their finances. They might be dealing with young children at home, or with sick or elderly friends and relatives, or with both. Because they are frightened and preoccupied, they don’t have a lot of mental bandwidth to manage sludge, whether it comes from the government or the private sector.
For many people, that’s true in the best of times, of course — which is one reason that any year is a good year to remove sludge. But in a time like this, the bandwidth problem is immeasurably worse for many millions of people.
If we want to help people survive economically, or get medical help to them, public officials should be eager to simplify, to waive onerous requirements and to make economic or other assistance automatic. Sludge removal might not seem like the highest priority, but it can make the difference between relative comfort and acute hardship — or even life and death.