NIH Fixed Cost Cap Allegory – Healthcare Blog

Gregroy Hopson
The family restaurant in T-Maître Pierre is a Louisiana agency. The kind of place where generations gather on boiling crayfish, spicy corn and seasoned potatoes. Where Clifton Chenier's Louisiana Blues and Zydeco play in the background, Waitstaff wore a starchy white shirt with a bright bow tie. Photos of faint smiles on the walls. No one knows who they are, but they feel like family.
Founder Pierre Thibodeaux ensures that every customer is treated as if they are indeed family. Therefore, it is ironic that when he died, he had no heirs.
In a week, the restaurant was acquired by multi-million-dollar developer Ob Soxious, who spoke to reporters under the banner:
Make crayfish amazing again
“They call these crayfish lobsters. Very clever. I like it. We want to keep the name. Everything else? Outdated. Inefficient. Sad.
To oversee this transformation, the harmful people brought Otto Maladore, a consultant known for running a multibillion-dollar company and did math in his mind (he did all the research too).
Maladore took thirty minutes to walk around the property, leaning over, holding on to it, and taking a step back while shaking his head. Not long after, he released a report to the media:
- Too much labor: “Awaiting the staff, the custodian, the dishwasher? They aren't cooking, so we're wasting money. Eliminating all these positions.”
- Simplified menu: “Boiled crayfish are beyond everything. Eliminate everything else. Eliminate the menu itself. The menu is nothing more than administrative swelling.”
- Decorative style: “We will have the best of everything. These photos are faded and the new ones are of low quality. Remove them.”
- modernization: “Discovering IBM 5150 is still running their books. It fascinates me and focuses on many different levels of me.”
- Fixed Cost: “This place is bleeding due to overhead costs. 40% of the facility and management revenue? It's crazy. Ten percent of people are enough for a place like this! But we have to be generous and more compassionate than the credibility people give us. So we won't be limiting 10%. We're going to hit 15%!”
Changes happen quickly overnight.
When customers showed up the next day, they found no music. No waiter. No atmosphere. Just fold the chair, a tortured old card table and flickering fluorescent lights (they were told the remodeling will take place later). The walls are exposed, except reading the sign:
Crayfish from T-MaîtrePierre
Read carefully!!!!!!
- Go to the rear parking lot and log in.
You will be assigned a ten-minute slot. - You will receive:
one. Live crayfish
b. Corn is not shaped
c. Potatoes (high quality dirt: pH between 6 and 6.5) - Preheat the boiling pan to exactly 212°F.
Do not add or remove water! - Spice level is preset.
- Napkins Extra: $0.25 per
- Improper disposal of corn husks: 10% surcharge
- Failure to remove crayfish on time can lead to food confiscation.
No exceptions, no refunds!
A middle-aged man wearing a Ragin'Cajuns hat reads the instructions aloud. Then he looked around, and the solemn customers lined up behind him. The place is quiet except for some muffled sounds in the kitchen. He took off his hat and looked heaven, pausing and murmuring to himself:
“Mais, Ça, C'est Pas Bon.” (Man, that's not good.)
By the end of this week, two of the three chefs were enough to rent pots and pans and argue about the right to burners. They moved to California, where a Chinese restaurant offers a fully equipped kitchen and covers overhead. Within a few weeks, they introduced Admiral Pierre's crayfish, which was accidentally imported from Chinese residents of Louisiana crayfish in the 1930s.
Back in Louisiana, the rain was even harder, and the only remaining chef stood deep in his ankle, scolding a puddle customer for the later crayfish stuffing his crayfish into the pot.
Morality
This happens when outsiders impose any cost caps in the name of “efficiency.”
T-Maître Pierre's leech did not fail. The reason for failure is that it loses the infrastructure that makes meals, burners, tongs and people possible. Once known for his recipes and techniques, the chef is now standing in the rain, helpless and without the tools he relies on. The recipes are still there, but the client now has to work hard to bridge the gap, abandoning the fun and ease of dining together.
NIH’s facility and administrative (F&A) cap is no different. It cuts the funds for the basic elements that enable research to flourish: lab space, equipment, compliance personnel, and humans who know how to maintain complex machinery such as autoclave. Researchers who once received the ability to infrastructure and expertise, pieced together their innovative booths as their benefactors scrambled to the top.
At T-Maître Pierre's, you're stuck in the rain, trying to figure out how to cook the crayfish. When you ask for help, the chef will answer:
“Je suis l'uniq qui rete, pisçac'est tout ce que j'ai.”
(I'm the only one, that's all.)
Under the NIH's 15% cap, your research institution is trying to fund the autoclave by disassembling the sofa to discover any loose changes that may fall out of the visitor's pockets. Even this source is making changes in Paypal and Venmo.
Working remotely from Baton Rouge, Louisiana, Gregory Hopson is a business intelligence developer at Emory Healthcare in Atlanta, Georgia.