David Broder and Why Government Doesn't Work (Revised)

David Broder's column today in the Post illustrates why government has problems working effectively. Mr. Broder writes in praise of an initiative by HHS secretary Leavitt to set up four sets of standards.

"One would standardize systems for registering patients and listing their prescriptions and other basic medical data so they would not have to be entered on separate clipboards with each visit. A second would set standards for equipment allowing remote monitoring of chronic illnesses, such as the blood sugar tests required by diabetes patients.

A third would focus on systems for exchanging medical test results from office to office. And the fourth is a 'biosurveillance system,' designed to alert public health officials to any change in the pattern of reported illnesses that could be an early warning of a pandemic.

Once the standards are set, he said, they will be applied in the purchase of systems by Medicare, Medicaid and the departments of Defense and Veterans Affairs, creating a market that the private sector is likely to follow."

All of this seems praiseworthy; certainly it did to Mr. Broder. So why do I take a contrarian position? It's not simply my advancing years, although to be truthful my problems are specifically with the first and third and are not based on any particular research.

[Updated--what follows is in error and will be revised. Meanwhile ignore it.]

My reservations are founded on the idea that HHS doesn't have this authority or a government wide mandate. If Bush or Andrew Card had given Leavitt this charge, we no doubt would have heard of it. My bet is that Leavitt is mostly unaware of the e-government initiatives,
specifically the Federal Enterprise Architecture. Leavitt is a policy man. He has seen a need and is moving to act. He's told his policy people to do this and they've saluted and said yessir. But the FEA is a technocrat's dream, which (odds are) Leavitt has never heard of. As the policy people work with the technocrats, they'll bump into these requirements, which will slow progress to a snail's crawl. This division between policy and technology is wide and deep and is always a major impediment to progress. Both Clinton (Gore's "Reinventing Government") and Bush come into office talking big about rationalizing government. But it doesn't happen. (It didn't happen when LBJ tried to apply McNamara PPB system, when Carter tried to apply zero-based budgeting, etc. etc.)

Even if Leavitt is effective enough within HHS to get this done, it's unlikely to work with DOD and VA. They have their own systems (VA at least is getting good press on the effectiveness of its system) into which their people have invested years of work. They will pick holes in HHS's proposals. Result: controversy, conflict and delay.