Accountable Strategies blog

A blog about accountability issues in the public, private, and nonprofit sectors

Posts Tagged ‘government’

On polls about government and health care

Posted by David Kassel on September 8, 2009

The trouble with basing political decisions on polls, as many elected officials and politicians do these days, is that most polls don’t seem to be very good at measuring people’s real opinions. 

The reason may be that those opinions are likely to be mixed–even among the same people on the same issues.

For instance, a New York Times  poll in July found “a nation torn by conflicting impulses and confusion”  about health care reform.  In the poll, 75 percent of the respondents said they were concerned health care costs would skyrocket if the government didn’t step in to provide a health care system for all Americans.  Yet the same poll also found that 77 percent were concerned costs would go up if government did create such as system.

How do you base political and policy decisions on results like that?

That same confusion and ambivalence appears to characterize American’s feelings about government in general.   PA Times, a monthly publication of the American Society for Public Administration,  reported that 79 percent of Americans say they would encourage young people to work for the federal government.  This finding came out of a George Washington University Battleground Poll, conducted in July.  

Yet, according to the same poll, only 21 percent of the respondents had a great deal or a lot of confidence in federal civilian employees.

But before getting too discouraged about government, big business, newspapers, and HMOs fared as badly or worse in a similar poll conducted by Gallup in June, according to PA Times.  In June, Gallup asked a similar question about confidence in employees of several professions.  Among the following institutions, the level of confidence held by respondants was:

Newspapers (25 percent), TV news (23 percent), banks (22 percent), organized labor (19 percent), HMOs (18 percent), Congress (17 percent), and big business (16 percent).  On the other end of the spectrum were the military (82 percent), small business (67 percent), the police (59 percent), and organized religion (52 percent).

The question Gallup asked was:  “Thinking about the civilian employees of the federal government and your view of them, would you say that you have a great deal of confidence, a lot of confidence, some confidence, or very little confidence in these employees?”   The George Washington University poll excluded the military, which tends to draw higher public confidence than other institutions.

This type of question and the responses to it illustrate some inherent weaknesses in polling.  People’s feelings and beliefs about these issues are clearly mixed.  They are based on presumptions that may not always be examined or questioned.  On the one hand, the George Washington University poll shows that people have little confidence in the federal workforce.  Yet, they endorse it as a profession for young people.

Similarly, polls, such as the Gallup poll, show people hold Congress in the lowest esteem among practially all institutions.  Yet, late last month, we saw an  outpouring of public emotion at the passing of Senator Ted Kennedy,  albeit a famous and unusually productive member of Congress.

Like statistics, polls can be made to say just about whatever you want them to.  We should pay far less attention to them than we do.

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Governmental efficiency and the fate of the Fernald Center

Posted by David Kassel on October 11, 2007

In an article in the current (September/October) issue of Public Administration Review, Hindy Lauer Schachter argues that governmental efficency is a political concept.  

Efficiency inolves getting the biggest bang for the taxpayer’s buck–“maximizing the ratio of outputs to inputs” in public administration jargon.  Everyone is in favor of it, and virtually every governmental reform effort has put efficiency at the top of its list.

But Schachter notes that in the public realm:

…political decisions undergird which numbers count, which data constitute benefits, and which are costs.  Governmental efficiency exists in a specific political context.

Reading the article brought to mind a political debate that has been ongoing in Massachusetts over continuing attempts by the then Romney and now Patrick administrations to shut the Fernald Developmental Center in Waltham, MA, the nation’s oldest state-run facility for people with mental retardation.  (By way of disclosure, I have been doing consulting work for the Fernald League, a nonprofit organization of parents and relatives of the Fernald residents, which is fighting to keep the facility open.)

The Patrick administration has put forth an efficiency argument in favor of closing Fernald and ultimately transferring the remaining 180 residents to privately provided, community-based care.  A statement issued in September by the Executive Office of Health and Human Services maintained that Fernald was the most expensive state facility in Massachusetts, with an operating cost in excess of $239,000 per resident, compared with a cost-per-resident of “comparable” community-based care of $102,000.

The EOHHS statement was issued in conjunction with the Patrick administration’s decision in September to appeal a U.S. District Court judge’s ruling that Fernald must remain open to its current residents.

Uising that high comparison cost figure for Fernald may well be a politically effective strategy, given that we are a society in which, as Schachter notes, efficency is a treasured value.  The use of comparison costs appears, on the surface, to take politics out of the discussion.   Whether or not you agree with the political arguments for or against privatization, you can’t argue with the numbers when they’re put before you so starkly.

But do those numbers have any basis in reality?  The EOHHS statement contained no backup or indication as to how the $239,000 and $102,000 amounts were derived.  And yet, the figures were uncritically cited the next day by news media outlets throughout the state.

It’s quite difficult, however, to determine the true cost-per-resident at a complex facility such as Fernald, and potentially even more difficult to determine that type of cost in a sprawling community-based system of services.  For instance, at Fernald, you can’t just take the total facility budget and divide it by the total number of residents to arrive at a true cost per resident.  The reason is that the Fernald budget covers a number of costs that don’t directly or exclusively benefit the residents.  (By the way, the Massachusetts Coalition of Families and Advocates for the Retarded, Inc. (COFAR) filed numerous Public Records Law requests over a period of several months last year in order to get even rudimentary budgetary figures for Fernald from the Department of Mental Retardation.)

Take the skilled nursing facility on the Fernald campus, for example.  The cost of operating the nursing facility, which serves 25 patients, appears to fall under the Fernald budget (although even that is unclear, based on the DMR information that was provided to COFAR).  Yet, the nursing facility is open to all clients of the DMR system, not just the residents at Fernald.  Those 25 patients aren’t even counted among the 180 remaining residents at Fernald.

A couple of other facts to consider, based on an an analysis earlier this year by COFAR of the DMR cost information: Fernald residents share the use of at least 12 buildings on the campus with community-based clients and derive no apparent benefit from eight other buildings.  In addition, nearly 30 buildings on the campus are unoccupied.  Yet virtually all the buildings on the campus are connected to the campus heating and electricity infrastructure.  Those costs are part of the Fernald budget, but should they all be attributed soley to the residents?  COFAR also found out that the $91,900 salary of the director of the Hogan Regional Development Center in Danvers, MA, was inexplicably listed on the payroll of the Fernald Center (See May 2007 COFAR Voice, p. 5).

Then, there’s the whole thorny question of how the administration came up with the $102,000 per-resident for care in the community.  Despite the apparent specificity of that and the Fernald cost number, there is no way anyone can proclaim them as absolutely truthful or even as reliable.  

The Fernald situation demonstrates that it’s impossible to remove politics from cost/benefit analyses of public functions.   Given that reality, Schachter maintains that it’s important to engage citizens and:

…make them more visible and connected to the way political officials and administrators define costs and benefits…Citizen involvement is a prerequisite to meaningful cost-benefit calculations.

I would suggest that at a minimum, citizens need to be informed about the complexities of governmental policies, such as the decision to privatize services for the mentally retarded.  The problem is that when the public administrators justify their actions with simplistic explanations and the press accepts those explanations uncritically, the citizens don’t have much of a chance.

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The continuing attack on bureaucracy

Posted by David Kassel on October 3, 2007

Kennedy School of Government Lecturer Elaine Kamarck has just published a book called “The End of Government…as we know it,” in which she argues that traditional forms of bureaucratic government are giving way to “reinvented,” privatized and “marketized” forms, and that this is largely a good thing.

Kamarck was in charge of the “reinventing government” effort in the Clinton-Gore administration, and she naturally argues that reinvention is one of the key characteristics of the “post bureaucratic” state.  “Reinvented government” is government that acts more like business.  In reinvented government, performance is more important than process, burdensome budget and procurement rules are lifted to allow managers flexibility to get results, and citizens are treated as “customers,” among other innovations.

I focused on Chapter 3 of Kamarck’s book, titled “Democratic Accountability,”  in which she lays out the basis of her argument that traditional bureaucracies have depended on adherence to rules and process to the detriment of performance and innovation in government.  It’s a seductive argument because it beats up on a target that we all like to beat up on–the hapless, mindless, rules-following bureaucrat. 

In fact, Kamarck’s argument follows a tradition in recent years of attacking government bureaucracy–a tradition that she herself traces back to Michael Barzelay’s 1992 book, Breaking Through Bureaucracy.  Most, if not all, of the attacks that have been levied from Barzelay on have focused largely on  bureaucrats and the bureaucratic rules they follow as they bog government down and prevent it from getting necessary things done.

The problem is that these broad attacks on bureaucrats and rules often lead to contradictions in the arguments put forth by the “government reinventers.”  After all, aside from out-and-out anarchists, most sane people would agree that at least some rules are neccesary to allow our government and society to function with any degree of normalcy.   They also help preserve basic rights for citizens in their dealings with government, through such things as the Freedom of Information Law and the other laws and rules that allow people to sue government when rights are taken away.  “Process” actually doesn’t sound so bad when the word “due” is put in front of it.

Yet, in her enthusiasm for the reinvention ideology, Kamarck makes a number of broad and sometimes unsubstantiated attacks on rules and traditional bureaucracy.  In Chapter 3, she charges, for instance, that inspectors general in the federal govenment support a “rule-based culture” that has “added to (government) waste instead of subtracting from it.”  By way of disclosure, I used to work for the Massachusetts Inspector General’s Office, so it comes as a bit of a painful surprise to learn that I’ve been part of a culture that has added to government waste.

Yet, still continuing her attack, Kamarck goes on a few pages later to praise a federal IG.  She describes a situation in which Clark Ervin Kent, the first IG of the Department of Homeland Security, was removed from his job by the White House after he exposed weaknesses in the nation’s airport security system.  Kent’s investigators had been able to sneak weapons and explosives past screeners at 15 U.S. airports in 2003.  The White House was not happy about Kent’s expose of DHS ineptitude. 

Kamarck argues that Kent was forced out because he had “sought to focus on (governmental) outcomes [which are good things to focus on]  and not process [which is a bad thing to focus on].”  But, in fact, Kent’s investigation of the airport security system really focused on both outcomes and process.  He was forced out because he exposed weaknesses in both. 

 Sure, Kent had uncovered major lapses in governmental outcomes or performance in airport security.  But these lapses were no doubt due, at least in part, to failures in processes and in following rules involving such things as proper training and deployment of security personnel. 

The problem with these types of attacks on rules and bureaucracy is that the logical implication is that if we would only let managers do their thing freely—such as allow airport security managers to ignore written rules and procedures in order to devise their own security innovations—we’d all be safer.   Somehow, I can’t believe Kamarck really believes that.

Kamarck’s reinvention ideology also leads her to praise a move by the Bush administration to exempt the Department of Homeland Security from civil service rules.  She writes:

…when the Bush administration set out to create the Department of Homeland Security it tried to incorporate many of the management flexibilities that are core concepts in reinvented public-sector organizations, including some modest authority to reprogram funds without prior congressional approval and substantial flexibilities in procurement and civil service laws.

What Kamarck doesn’t say here, though, is that while the Bush administration was successful in creating a new personnel system at DHS, it doesn’t appear to have helped the agency’s performance.  Ironically, one of the many failures in that performance has been the continuing inability at DHS to identify counterfeit drivers’ licenses and other forged documents in screening people trying to enter the U.S.  The Governmental Accountability Office, carrying on in Clark Ervin Kent’s tradition, has repeatedly been able to sneak agents with fictitious documents through DHS border security.

Kamarck actually seemed more critical of the supplanting of traditional government bureaucracy by privatization, if not reinvention,  during a discussion on her book at the Kennedy School earlier this week.  Nevertheless, it was disappointing to me that in her chapter on democratic accountability, in particular, Kamarck has largely framed the accountability issue in terms of governmental performance.   She contends that accountability is lessened when government is privatized because no one is adequately measuring performance.   

That is certainly true; but accountability in privatized government is also lessened because, among other things, bugetary and other information is less accessible to the public in privatized functions than in public functions.  As Gilmour and Jensen have pointed out, laws such as the Administrative Procedure Act, which opened the federal bureaucracy to public scrutiny, and the Freedom of Information Act, don’t apply as consistently in privatized situations as they do in purely public transactions.  And those types of things just happen to be process issues.

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