Public/Private Partnerships--Bureaucratically Problematic

Following on yesterday's post about the problems of implementing the Medicare Part D plan, Jacob Weisberg has an interesting article, Drug Addled - Why Bush's prescription plan is such a fiasco, in Slate. He observes that programs that try to partner public and private entities are more complex. And he makes the parallel with the Clinton health care plan in 1994. Recommended reading.

First Time Problems or Misdesigned Program

Today's Post has an article describing reactions to the problems in the implementation of the new Medicare drug insurance plan (Part D). HHS Secretary Leavitt says:

"'Since this is a new program, some people may experience a problem the first time they go to get their medicines, but we're confident that after you use it once, things are going to go more smoothly,' he said. 'If you are one of those seniors experiencing problems, our message is don't leave the pharmacy without your drugs.'"

Remember my Harshaw Rule 1.

It's possible that the program is misconceived and impossible to administer well through the congeries of state and private organizations that must cooperate. I certainly don't envy the HHS bureaucrats. But it's also possible that with time and experience people will adjust their behavior and make it work. After all, that's how our present health care system has evolved, though some may quarrel with the idea that it works.

Bureaucracy in Body Armor

Re my blog on Mr. Bremer, Andrew Exum had an op-ed in the Times that leads off:

THIS week Senator Hillary Clinton, citing a secret Pentagon report that suggested some marines killed in Iraq might have survived had they been wearing more body armor, became the latest in a long line of politicians to castigate the Pentagon for a supposed failure to adequately protect our fighting men and women. Well-intentioned as the senator might be, the body-armor issue, like so many in war, is just not that simple.

The point he goes on to make is that troops need mobility and endurance, particularly in 120 degree heat. So each added pound of armor comes at the cost of less speed, less staying power. Efforts in the press (including a piece on Lehrer PBS Wed. night) to charge the administration with not protecting troops are overly simplified.

How does this tie with Bremer's bureaucratic rules on procurement--the same style of thinking applies in both. You focus on one thing (preventing fraud, preventing lethal shots from the side), propose a solution (more rules, more armor) and lose some ability to achieve your larger objective.

Update: Watched "Black Hawk Down". (I'd read the book before, but just got around to the movie.) When the Rangers loaded up for the raid, the movie shows them leaving behind some armor and other equipment they don't think they'll need.

Bureaucracy in Times of Crisis

Mr. Bremer had an op-ed in the NYTimes last week with observations on the lessons he learned in Iraq and the interpretations of his new book. As a bureaucrat, I found this interesting:

"I should have also insisted on exemption from the usual bureaucratic and contracting rules. This lesson was brought home to me in a dramatic fashion a few weeks after I arrived. We had learned that six major hospitals in Baghdad urgently needed new generators to run their operating rooms and air-conditioning plants. Our budget director told me I could use American funds, which were subject to United States federal contracting rules, or Iraqi government funds, which were not. Using American money, he told me, would mean waiting four to six months for the generators. We used Iraqi funds and got the equipment in eight days. In the future, Congress must make provisions for legitimate exemptions."

Fair enough, but as soon as GAO and the press find fraud in the use of money, Congress has to do something, which is to add levels of review. See my post on body armor.

Falling Tides and Boats

JFK famously said "a rising tide lifts all boats". It's a favorite mantra of liberals--a way to finesse conflicts over distribution of wealth by encouraging economic progress. Benjamin Friedman has written "The Moral Consequences of Economic Growth" arguing that growth makes it easier for people to be virtuous, tolerant, and democratic. [Disclaimer--I've noted the favorable reviews but not read the book, yet.]

But how about the obverse? What happens when an organization loses income, a church loses members, a town loses population, a corporation loses profitability? Do they gracefully fade away into the mists of history, along with various Indian tribes? Or do they fight, fight against the dying of the light? Do they come together, joining forces against the common enemy? Or do they sputter out in recriminations, in animosity? See Jared Diamond's "Collapse", which I have read and recommend.

Why "Monkey See, Monkey Do' Works for People

The Times Tuesday, in Cells That Read Minds, reported on interesting research. Scientists are watching primates (first monkeys, then humans) to see what cells were activated when we watch other primates:

"The monkey brain contains a special class of cells, called mirror neurons,
that fire when the animal sees or hears an action and when the animal carries
out the same action on its own.

But if the findings, published in 1996,
surprised most scientists, recent research has left them flabbergasted. Humans,
it turns out, have mirror neurons that are far smarter, more flexible and more
highly evolved than any of those found in monkeys, a fact that scientists say
reflects the evolution of humans' sophisticated social abilities.

The
human brain has multiple mirror neuron systems that specialize in carrying out
and understanding not just the actions of others but their intentions, the
social meaning of their behavior and their emotions."

Can You Identify the Original 13 Colonies

History News Network provides this reminder of eternal truths--the young don't know their history.

"“Ignorance of U.S. History Shown by College Freshmen” trumpeted the New York Time’s headline on April 4, 1943, a day when the main story reported that General George Patton’s troops had overrun Erwin Rommel at Al-Guettar. Providing support for Allan Nevins’s claim that “young people are all too ignorant of American history,” the survey showed that a scant 6% of the 7000 college freshman could identify the 13 original colonies, while only 15% could place McKinley as president during the Spanish-American War. Less than a quarter could name two contributions made by either Abraham Lincoln or Thomas Jefferson. "

Poorly Performing Bureaucrats

Some would argue that my title is an anti-oxymoron, a redundancy. But today's Federal Diary in the Post discusses (Is the Annual Performance Review the Goof-Off's Best Friend?) a proposal from a Harvard man, Robert Behn (see his newsletter here):

"Behn argues that most agency managers have only two choices when trying to fire employees who don't pull their weight: Launch an all-out attack using the full powers of the personnel system, or shrug off their lackluster performance and give the employee a passing grade, such as 'meets expectations' or 'satisfactory.'

Agency managers are not dumb or incompetent in their handling of poor performers, but they understand that there is only so much time in the week, the month and the year, Behn says. Managers can focus on a few important problems and try to make a difference on behalf of taxpayers, or they can go to war with employees who know the workplace rules and are 'willing and able to use them' to protect their jobs, Behn writes."

I agree with the analysis. I'm dubious of the proposal, which is to eliminate yearly reviews and just rely on letters of commendation. The bottom line is that managers, like other Americans, don't like face to face confrontations (in the blogosphere is okay, but not where it counts). So they need strong incentives to manage people well.

Hedgehogs at the White House

Via Dan Drezner an article from the Wall Street Journal--WSJ.com - The Numbers Guy (free)--on Professor Tetlock's book, Expert Political Judgments. He used Isaiah Berlin's categories:

"Foxes [those who know many small things] outperformed hedgehogs [those who know one big thing] in nearly every measure, Prof. Tetlock said. That suggested that those with flexible thinking were better equipped to make forecasts.

Foxes were better, by about three times, at adapting their predictions to world events they hadn't expected. This relates to another failing of hedgehogs: they tended to be more likely to engage in 'hindsight bias.' In other words, hedgehogs were more likely to err in their own favor when asked to recall past predictions -- and if they couldn't recall their own mistakes, how could they be expected to learn from them?"

See Louis Menand in The New Yorker for a fuller discussion, including the points that people make their information fit their preconceptions, discounting opposing information, and that the premium is on "experts" to offer new and different predictions. But hedgehogs can be spectacularly right (particularly scientists).

IMHO our President is a hedgehog (most politicians are, regardless of ideology, although Bill Clinton could not have been), so it's not surprising that it takes a while for bad news to sink in.

How Government Really Works IV

Following up on yesterday's them, Slate has this article--
Lobbying and Laziness - It's not just about greed. It's about loafing. By John Dickerson:

"The more effective scenario, [ than exchanging money for votes] for everyone concerned, involves the lobbyist becoming friendly with members of the Congress member's staff, who research issues and advise him or her what to do and how to vote.

When the member of Congress goes to staff for information, he wants it fast. A staffer can read all available material on the issue, think through the policy, and balance what's right against the member's political interests—or he can call his friend Smitty the lobbyist. Smitty knows all about this complicated stuff in the telecommunications bill. He was talking about it just the other day at the Wizards game, which was almost as fun as the Cointreau-and-capon party Smitty hosted at his spread in Great Falls over Labor Day.

Smitty has a solid, intellectually defensible answer to every question. He also knows how an issue is likely to play out politically for the member back in his home district. In a hectic day, Smitty makes a staffer's day easier. That's almost as appealing as the skybox and the free drinks. It's easy to rationalize relying on lobbyists for this kind of help. In asking lobbyists to help them understand technical issues, staffers are doing the same thing journalists do every day—and in fact, journalists often call the same lobbyists for the same reason. They find someone who understands the issue, figuring that they're smart enough to use the information that rings true and discard the spin."

I.e., like the President with his slide briefings, Congress members and staffs are dependent on others for information. And it's true that most every issue can be given a reasonable justification.