ENFORCEMENT VERSUS REINFORCEMENT: from my book "Restore Elderpride Resolve Eldercide". Xlibris 2012

Will the use of reinforcement to replace enforcement improve the outcome for injustice and racism? This symbiotic pursuit of equality can be traced to the current use of enforcement versus reinforcement of the law and regulatory system we have in America.  My family and I were consultants to nursing homes for twenty years and owners for seven years.  We had a mission to change the culture of inhuman treatment of the elderly in nursing homes.  This grew out of my being a CPA who was involved in implementing Medicare and Medicaid rules and regulations in the late 1960's and 1970's.  I was a consultant with Arthur Andersen & Co. the largest public accounting firm in the country at the time.  Our client Blue Cross of America gave us the assignment to teach physicians, hospitals, nursing homes, etc. how to bill and report costs for inpatient care.  Later outpatient and hospice were added to the rules. Over the years the enforcement of the rules and costs expanded at a frightening rate.  The Federal government (Congress) assigned the implementation of Medicare and Medicaid to the States who then developed survey teams to enforce the rules by later imposing fines and threats of imprisonment for those providers who, according to their arbitrary and capricious interpretation of the law were penalized with civil money fines and denial of claims, that violated their fifth amendment rights to due process.  The Federal Fifth District Court found that this deprived the beneficiaries of Medicare and Medicaid right to insurance coverage.  Our consulting business was to assist the providers to appeal those Fiscal Intermediary decisions and resulted in other law suits that the Department of Health and Human Services and Public Health officials ignored.   My reasoning for proposing a change in the enforcement tactics by the survey process to implement reinforcement rules to promote better care for better reimbursement.  This was implemented in Illinois in the 1980's and worked for those providers who qualified for the six stars of quality as defined in the State Survey rules.  Although that system was extremely successful while I was managing skilled nursing facilities the large chain operators got it thrown out because their facilities couldn't meet the quality of life standards of each star while the excellent facilities who were in the 5- and 6-star category were getting civil money bonuses for each star attained.  And my facilities qualified for the maximum of 6 stars and got hundreds of thousands of dollars for excellent quality of life outcomes. My point is the use of reinforcement rather than police enforcement for compliance to the rule of law may well solve the problems we are having with the Black Lives Matter violent response. Rather than un-funding the police we need to use humanism rules for maximizing quality of life. This could be done using a social service division in the police departments assigned with the responsibility of quelling social injustice that escalates out of social compliance with our rule of law. Under the six-star system the nursing homes improved by using reinforcement surveys looking to reward quality with better payment rates rather than penalties for non-compliance … proving that reinforcement works and enforcement doesn’t. In essence a reinforcement approach is humanitarian for the sake of equal treatment and incentives for treating encounters as an opportunity to practice humanism.  It doesn't require more and more laws and regulations and more policing it establishes humanity as its objective and each individual as its subject.  Then logic and common sense can be the approach rather than wielding guns, knives, bayonets, pipe bombs and fires that escalates into losing lives for what ... riots and de-funding our security or civility, resolution of the injustice and honoring differences.