Why I Got It Wrong

My post on Mr. Broder's column was wrong, at least in part. Why did I screw it up?

1. Impatience. As I grow older I seem to be more slapdash, meaning I focus on some things and miss others. I read the piece as Secretary Leavitt pushing his four "breakthrough projects" and missed the segue into the fact that he's more interested in treating New Orleans as a clean slate to redo healthcare.
2. Laziness. In my defense I flagged the fact I hadn't done research, but that's hardly valid in the days of Google. Just a minute of drilling down the http://www.egov.gov site brought up lots of background on Leavitt's four initiatives. The effort began in Clinton's time, includes an executive order from Bush, and this American Health Information Community (the Community) Workgroups Web site.
3. Misplaced self righteousness. Because I knew so well the problems and processes of trying to redo areas of USDA, I thought the same was true of Secretary Leavitt's effort. I jumped to conclusions--taking a couple bits of information from Broder's column and fitting them into an overall structure derived from past experience. I didn't allow for change and difference.
   

These faults are characteristic, both of me and often I think of others on the Internet.

Invading Privacy II

The Post reprinted this article from the Chicago Tribune | They've got game--and hijab " discussing Muslim girls playing basketball in the Chicago area.

"Duaa Hamoud holds a basketball to her hip. She is standing in a long blue gown in a gym at Bridgeview's Universal School. Her head is covered in a white scarf pulled tightly around her neck. Not a wisp of hair is showing.

Around her, other high school girls dressed in similar flowing robes shoot a few casual baskets while they wait for practice to begin. There are no men in the gym--no male coaches, no boys from school, no dads or brothers in the bleachers.

So when the coach arrives and the real training starts, they can peel off their Islamic dress, exposing their sweat pants and short-sleeved T-shirts underneath."

What interested me was the accompanying picture, taken by a woman, which showed some of the girls on the court, most of whom were in the robes, but one of whom was in sweat pants and shirt. It's not clear whether that was a mistake, whether the particular girl was less particular about the rules, or what. Anyhow it raises the subject of Islamic privacy and the rules of the various bodies within Islam as to what is appropriate dress in which contexts. I take it as saying that Islam wants its adherents to control their privacy, to be able to say how much of their body/face is revealed to which others. This seems to me to be an attractive metaphor for overall issues of data privacy. We as citizens want the ability to control how much data is visible to different groups.

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.

WSJ.com - How the Amish Drive Down Medical Costs

I don't normally go near the Wall Street Journal, but they do have some free articles and here is an excerpt from one--dealing with how the Anabaptists (Amish, Mennonites) deal with modern medicine.
How the Amish Drive Down Medical Costs:

"Heart of Lancaster is a small hospital, and its case load is fairly conventional. But the Anabaptists weren't looking for anything exotic. They wanted discounts on services such as orthopedic surgery, biopsies and childbirth. The hospital agreed to discounts of up to 40% off its top rates, resulting in prices that would still be slightly higher than Medicare reimbursements, the level most hospitals consider a minimum. Not satisfied, the Anabaptists pushed the executives to go lower. But the hospital said if it dropped prices to levels below Medicare reimbursements, it could be charged for fraud for charging Medicare patients more."

The Amish, and the other Anabaptists, fascinate me. They form a test case for many theories. Are they really American? How should one deal with other cultures (like those who discourage higher education)? etc. etc. In this connection, I strongly recommend the book "The Riddle of Amish Culture"by Donald Kraybill.

"Portgate" and Hutchison Whampoa

There's a fuss about the possibility of a company based in Dubai buying the company that runs a number of major U.S. ports. Critics on both sides of the aisle are yelling about the threat to security. It all reminds me of the 1990's controversy over Hutchison Whampoa and its taking over operation of the Panama Canal. In sum, an opportunity for some demagogery without substance.

Bigshottery, or You The Man

Christopher Lee has a good piece, albeit a bit lacking in cynicism, on backgrounders in the Post: Remember, You Didn't Hear This From Me . . .:

"Agencies cite any number of reasons for keeping names out of the press: allowing lower-level officials to be quoted might steal the spotlight from the Cabinet secretary or other high-ranking official; the briefers are policy wonks who are uncomfortable talking to reporters; the agency is involved in an issue, but in a supporting role; the officials are there to provide context or technical explanations as a courtesy, not to be the face of an agency."

My dyspeptic take: What much of this boils down to is that agency heads are ignorant bigshots. They don't know enough to be talking in detail to reporters and they want all the glory they can get. (It's a truism that the first thing any Beltway type does when picking up a book is to look in the index to find his or her name.) "Heads" want to be the "face" of the agency, not the brains, to be "the man".

But putting on my pseudo-economist glasses: any backgrounder involves a quid pro quo. The reporter likes it because they don't display their ignorance, as they might have to do in an open press conference. The official likes it because their hard-earned knowledge, won by years of toil in the trenches, can at least be flaunted. The agency head will tolerate the backgrounders as long as they don't take away any glory or raise questions about the head. There's also a question of balance--if there are more reporters with more time/space to fill with stories than there are agency heads with knowledge to impart, the reporter goes down the food chain.

Not Surprising, Republican Judges See White Collar Crime as Less Serious

The Post reports on a study of how judges from different parties analyze crimes and sentence criminals here-- NOTED WITH INTEREST:

"Federal judges appointed by Republicans give tougher sentences on street crime, whereas Democratic appointees take a stricter view of white-collar offenses."

The summary could be reversed, as I did in the title. It's the usual problem with many two-sided issues: do you say boys are doing worse in school or girls are doing better in school? It's a reminder of the importance of context and framing.

FEMA and DHS

George Buddy asked about FEMA's proper role, specifically its relation to DHS. I think a part of the problems we saw with Katrina were caused by the DHS reorganization. There's no doubt that reporting lines got confused--Brown felt loyalty to the people who bumped him up from FEMA deputy director to DHS undersecretary, not to Chertoff who arrived later. When Brown had a hot potato, he turned to his friends, not to his new boss. Chertoff, who was relying on Brown to alert him to problems, had his focus elsewhere. Just as we didn't realize before 9/11 that bin Laden could mount an attack much deadlier than any previous one, he (and we) didn't realize that Mother Nature could also mount an attack more devastating than prior hurricanes.

It also seems clear that the Bush administration after Sept. 11 said that the "war" on terrorism was more important than disaster preparations. Congress agreed and pushed the DHS reorg. There was a smokescreen of rhetoric whereby the policymakers tried to convince themselves that DHS would be a more efficient use of resources. There's some logic to this--the response to a natural disaster and an attack will often be similar and the coordination with state and local first responders must use the same infrastructure. But the reality, as any experienced bureaucrat knew, was that creating DHS would cause us to be less prepared over the next few years, both for disaster and terror, than the alternative. The truth is any reorganization uses so much bureaucratic energy that the sum is significantly less than the whole for several years. So we won't know for another 10 or 20 years whether there's a net improvement or not.

Suppose Mr. Negroponte came to the President and said: "Sir, our enemy has dispatched a team that has the capability of killing a thousand people and destroying 50 billion dollars worth of property. Current intelligence shows that the team is likely headed for New Orleans and has a 50 percent chance of carrying out their mission." What would Bush do? He certainly wouldn't do what he did the end of August. (Or maybe I should say--he would do something, not nothing.)

The First Amendment Doesn't Apply Everywhere

This was an amazing story in this morning's Post--read the whole thing.

Policing Porn Is Not Part of Job Description:

"Two uniformed men strolled into the main room of the Little Falls library in Bethesda one day last week and demanded the attention of all patrons using the computers. Then they made their announcement: The viewing of Internet pornography was forbidden.

The men looked stern and wore baseball caps emblazoned with the words 'Homeland Security.' "

...[further on] The sexual harassment policy forbids the "display of offensive or obscene printed or visual material." But in a library, which is both a public arena and a county workplace, the U.S. Constitution trumps Montgomery's rules.

I was struck by the implication in the last sentence that the Constitution doesn't always and everywhere trump Montgomery County's rules. But I guess it's true--any employer can impose some restrictions not applicable in a public area.

[The men were employees of the Montgomery county Homeland Security Department trying to enforce a ban on accessing porn through government owned equipment.]

Participation in Organizations--Hirschman

I've previously blogged on Albert Hirschman's "Exit, Voice, and Loyalty : Responses to Decline in Firms, Organizations, and States". I just got through commenting on Caleb McDaniel's blog
using Hirschman's schema in connection with the abolitionists.

There's another aspect, particularly with voluntary organizations, like alumni associations/college trustee elections and homeowner's associations: how many people have to participate to make the election/vote binding on the whole? I just got a package from the Reston Association (the closest thing Reston has to a government) changing the quorum requirement to 30 percent. My cluster association has been unable to get 10 percent participation in the annual meeting. I think Dartmouth is trying to reduce its quorum percentage. Hirschman would interpret all of these as saying "voice" is silent because the members are satisfied.