Practical Solutions for Healthcare Management and Policy (Collection)

8. Sand in the Gears

“The insurance industry communicates through codes and check-off boxes. If there’s no check-off box for you, you don’t exist.”

—Jack Anderson

Anyone who has ever had an opportunity to work with motors or machinery knows the impact that foreign bodies such as sand or grit can have on gears and other moving parts. Not only do they make it hard for the gears to turn, but the damage they cause is expensive to repair. If the foreign objects are big enough, they can stop things entirely. A “wrench in the works” is the definitive example of a large foreign body, and symbolizes the externally introduced problem that makes it nearly impossible for a mechanical system to engage in productive activity.

For the purposes of our discussion, ...