What could unite us? Getting good value from government

by J. Peder Zane, News and Observer, January 15, 2014.

Most people abhor complexity. When problems arise, we search for the single cause and the easy solution. This is especially true in government, where scandals produce knee-jerk demands to immediately identify the “guilty party.”

Consider the recent debacles at the federal and state departments of health and human services.

As the feds grapple with the botched rollout of Obamacare, North Carolina’s DHHS is dealing with severe software problems in the system it uses to pay Medicaid claims, NC Tracks, and to handle its food stamp program, NC FAST.

I guess FAST means Folks Are Starving Today.

Quicker than Pavlov’s dog, partisans have been drooling to assign the blame to specific individuals. As Obamacare has unspooled, the right has clamored for the head of DHHS Secretary Kathleen Sebelius. Back home, the left has demanded that Gov. Pat McCrory fire the state’s DHHS leader, Dr. Aldona Wos.

Personal accountability is important. But in politics it is largely symbolic. The broken systems at issue are so immense that no single individual can make or break them. Leadership matters. But does anybody really believe that everything would be peaches and cream but for Sebelius and Wos?

The problem is not the player, it’s the game. Despite our urge to simplify these fiascos by casting them as isolated problems caused by incompetent individuals, they are evidence of a broader pattern of the massive waste and inefficiency that suffuse government.

For example, the state of Massachusetts reports that more than a third of its spending on its health care system – which President Obama proudly calls the model for Obamacare – may be wasteful.

That worked out to between $14.7 billion and $26.9 billion in 2012, or 21 percent to 39 percent of total health expenditures, according to the state’s Health Policy Commission.

The same holds true for the federal Medicare and Medicaid spending. A 2012 study by the Rand Corporation and former Medicare chief Donald Berwick found between $166 billion and $304 billion of unnecessary spending in the nearly trillion dollar programs. Researchers at the Dartmouth Institute for Health Policy and Clinical Practice have estimated that 30 percent of all Medicare clinical care does not improve health outcomes.

Even as the workplace has become safer, the number of Americans receiving Social Security disability payments has skyrocketed, from 2.7 million in 1985 and 5.9 million in 2003 to 8.9 million last year. New York City recently arrested scores of ex-cops and firefighters in connection with a disability fraud scheme.

Last March, the N&O reported that North Carolina’s Division of Employment Security “paid out an estimated $178 million more in unemployment benefits than it should have for the 12 months that ended in June, according to the U.S. Department of Labor.” The silver lining in this thundercloud was that our estimated error rate – about 12.59 percent – was only about 1 percentage point above the national average. Twenty-four states fared worse.

Hooray for the mediocre middle!

In fairness, calculating waste and inefficiency involves many judgment calls. That is one reason the estimate range is so broad. And, in many cases, the problem is not just the government but the private individuals and companies that it relies on for information.

However, at a time when our politics is consumed by the pitched battle over the proper size and scope of government, those figures should serve as a mutual rallying cry for the left and the right. Instead of fighting over whether we should expand or contract programs and services, we should determine how to get more value for the money we are already spending.

By unlocking more money for services, this should please liberals. By making government more efficient and less expensive, it should also please conservatives.

Now for a quick reality check. At least since Ronald Reagan, every modern president has made eliminating waste and inefficiency a priority. Every president has failed miserably. It remains, simply, a talking point because it is hard to reform a government that is too big to fail and because even seasoned observers seem uninterested in addressing it. It’s the bureaucratic version of don’t ask, don’t tell.

An N&O editorial last Sunday criticizing McCrory asserted, “Promoting efficiency and customer service is fine, but it sets a low bar for a high office.”

In truth, it may be the highest bar.