This week my monthly column in The Cayman Islands Journal was titled “Public Servants – Gatekeepers or Guides” and focussed on the realisation that elected politicians can’t “fix government” on their own, in reality it has to be fixed from the inside, by motivated public servants.
In the current climate of need for massive budget cuts around the world, it is in gaining efficiency and effectiveness from the inside where savings need to be realised, more so than top down slashing and burning.
In interviewing senior civil servants in Cayman and Scotland for the column, I was both excited and inspired by what they had to say to me, plus they were all genuinely excited and pleased to see a coach and consultant with a career long private sector background talking about how he felt public servants could and should “be the change”.
To achieve this “from the inside” type of change though is not at all easy, as it requires a fundamental shift in thought process both inside and from outside the public service, and at all levels, from top to bottom of the public service. As a business coach, I see how working with business leaders and their teams in optimising their business can result in enormous positive changes, and I am excited to now be exploring this area with various public sector organisations.
Now, on that matter of changing how we think about effecting change in the public service. If you come at both stories from the idea of effecting change from the inside, this may change how you view each story (bold type is my added emphasis). I hope you are engaged and perhaps some of your ideas about government and public servants adjusted by considering the following two very recent stories.
Wisconsin – Medicaid – Rate Reform Project
From this Newsweek article – August 16th :
Medicaid is a lifeline for millions of uninsured Americans. For public officials, however, it’s often a quagmire—a program that drains as much as a quarter of total state spending, yet can’t be streamlined without political bloodshed. Previously, states have tried to rein in costs by pruning “optional” benefits (such as adult day care), reducing payments to health-care providers, or raising taxes, none of which are attractive choices in the era of the perpetual campaign. Could Wisconsin have a better way? Last year Gov. Jim Doyle proposed to slash $400 million from the state’s health-care system, one of the country’s most comprehensive. But rather than oversee the cuts, he and the state legislature left them up to Medicaid officials, who not only found the savings but expanded enrollment. The fixes, most of which kicked in this summer, were a predictable mix of new contracts and procedures…..But the approach upended traditional politics. Lobbyists lost influence, officials were insulated from blame, and lawmakers were shielded from “tough votes,” says Steve Barton, president of the Wisconsin Hospital Association.
And more on this from Stateline :
…the Rate Reform Project compiled, analyzed and debated 500 ideas. Some came from the Wisconsin Department of Health Services; others came from nine committees broken down by subjects such as hospitals, physicians, pharmacy, HMOs and long-term care. Legislative staff and policy experts weighed pros and cons and how much each idea might save. The proposals were put into an online survey for providers and other health care workers to weigh in on; all the while, department staff kept tabs on what options carried the most support and went farthest toward meeting the project’s goals.
By the time the work was done, the outlook for Wisconsin’s Medicaid program didn’t just include reduced spending. It also included an expansion of coverage for 41,000 childless adults, thanks to a new tax on hospitals separately enacted by the Legislature, as well as some federal dollars that came along with that tax. The sum was a carefully considered overhaul of a complicated program, which was no small feat at a time when many states have simply slashed spending with seemingly little regard for the implications.
Reforming Pentagon Spending
Coincidentally, in the same August 16th issue of Newsweek, came a column from Fareed Zakaria on how difficult it is to reign in spending on defence in the USA. Do read the full article, “Be More Like Ike“, and, in line with this blog, consider a) how difficult it is for elected politicians to effect cuts and efficiencies, and b) how it can only be done from inside.. but, in this case, it appears that the will is not there from the higher ranks.
These excerpts are telling :
“Nearly a decade ago, Secretary of Defense Donald Rumsfeld complained that there were 17 levels of staff between him and a line officer. Gates guesses that there are now about 30 levels.”
“Prof. Paul Light of New York University’s Wagner School of Public Service notes that in 1960 we had 78 deputy assistant secretaries of defense. Today there are 530.”
yet then :
“Any thoughts of broader reforms or even budget cuts seem inconceivable, despite the tremendous pressure on the federal budget.”