There’s a lesson in the European efforts to manage the economic crisis that threatens to sink the EU. I’m just not sure what that lesson is.
Greece and Italy have replaced their political leaders with well-regarded technocrats–men whose skills and qualifications for office are professional and intellectual rather than political. It’s hard not to see this move from glad-handing politicians to technocrats as an increasingly inevitable feature of modern societies; in today’s highly complex world, where local and global issues are more and more difficult to separate, “Mr. Smith goes to Washington” is untenable. People in positions of public authority need a level of education and specialized expertise in order to function adequately.
The promise of technocratic governance is that it will be grounded in understanding of the challenges confronting public managers today, and better able to meet those challenges. The peril is that technocrats will be too removed from the citizens they serve–too smug in their specialized areas of knowledge to recognize the importance of the people skills that come so naturally to “retail” politicians.
We need leadership that brings both kinds of skills to the job. And those folks are rare.
I always read Masson’s Blog, and always find him insightful, but this morning’s post on the mis-named “Right to Work” proposal is an absolute home run.
In an era that elevates spin over accuracy, naming/framing all too often substitutes for describing. “Right to Work” is a wonderful example–who could be opposed to people’s right to work? It is phrasing that feeds into the American belief in individual rights. And as Doug Masson explains, it is a phrase that has very little relationship to the reality of the legislation.
As Masson writes,
The perniciously named “right to work” is a misnomer. What the law really does is use government authority to prohibit a certain kind of contract. As it stands now, employers and employees have the freedom to enter into a contract whereby one of the conditions of employment is that employees join a union or, at least, pay some equivalent of union dues so they are not tempted to be free riders, receiving union benefits without paying for them. So, it’s a contractual provision that is currently permitted but not required. “Right to work” is a limitation on this freedom to contract. The General Assembly tells employers that they are not permitted to make union membership a condition of employment.
This is typically dressed up as championing the rights of future employees who might not want to join a union as a condition of employment; but the oddity is that typically the advocates of this restriction on contracts are, in other contexts, champions of absolute freedom to contract and could rarely care less what a potential employee thinks about the conditions of employment set by an employer. (Don’t like that condition of employment? Fine, go work somewhere else.) But, when union membership comes up, horrors! Conditions that are pro-union or anti-gun are off the table, but pretty much anything else goes.”
I’ve been following the Sunday series in the New York Times in which Ezekiel Emanuel—vice-provost and Professor of Medical Ethics at the University of Pennsylvania, and former White House advisor—has been explaining high healthcare costs.
I particularly appreciated this week’s discussion, “Billions Wasted on Billing.” My husband and I are at the age when doctor’s visits become more frequent, and I have weekly opportunities to open envelopes to read incomprehensible jumbles of medical and financial jargon under the heading “this is not a bill.” Anyone having experience with mailings of any sort—bills, invoices, reminders—knows that it is impossible to generate and mail anything for less than $5-$7 dollars, once you account for clerical time, stationery and postage. I’ve never understood why the same not-so-informative information can’t be included when the actual bill is sent.
Emanuel’s column was not just about billing, but about all the other repetitive, duplicative paperwork that characterizes our current health care system. How many times do we fill out patient forms with the identical information? How many insurance claims must be completed in different formats by all those white-haired ladies in colorful smocks sitting behind the glass partitions in your doctor’s office?
What does all this cost, and how much of it is really necessary?
According to Harvard economist David Cutler, electronic billing and credentialing could save the system upwards of 32 billion dollars a year. Transitioning to electronic record-keeping would pay other dividends as well: it would allow medical providers to use existing anti-fraud detection methods currently used by credit card companies, and it would minimize the errors that are inevitable when data is manually entered. (No longer getting “this is not a bill” mailings would also have a salutary effect on my blood pressure.)
What Emanuel’s column did not address is the question why medical insurers and providers have been so slow to adapt to the electronic age. I think a part of the answer is the complexity of what passes for a medical system in the U.S.—a complexity that also bedevils efforts to conduct reasonable policy discussions about health care in general.
We’ve all joked about the senior citizen at the Town Hall meeting who shouted “keep government’s hands off my Medicare.” It’s true that most Americans do know Medicare and Medicaid are government programs. We know that taxpayers fund the (much-lauded) Veteran’s Administration. But how many of us understand the extent to which government currently funds pharmaceutical and medical research? Or how much state governments contribute to the cost of medical education? To public health programs? How many of us know what local government units spend for everything from ambulance service to charity care?
I like to think of myself as informed, but I certainly don’t know the answers to those questions. I was astounded a few years ago when, serving on an academic committee dominated by healthcare professionals, I learned that government at all levels currently funds between 60% and 70% of all healthcare costs.
The real question isn’t whether we should have a government system or a private one. We haven’t had a private, market-driven system for decades, and for good reason. Markets require a willing buyer and willing seller, each of whom has the necessary relevant information and the ability to exercise choice. The real question is how to identify the measures that will reduce healthcare costs and improve patient care and access. Right now, we pay 2 ½ times what the next most expensive country pays for a system that ranks 36th in the world.
Here’s a question I often ponder–a conundrum for which I have no good answer.
I know literally hundreds of wonderful people. They will help their neighbors, pick up litter, donate to help the victims of hurricanes. They’ll take food to bereaved families, mow the lawn of an elderly neighbor. Actually, I know very few people who aren’t genuinely nice. Some are smarter than others, some are more obtuse or self-involved, but I really think most people are basically decent.
So why do those same people often behave so badly in groups? Why do people who would never intentionally injure a neighbor or co-worker support collective actions having no other purpose than to hurt a particular group of people? Why do people in crowds act in ways they wouldn’t individually?
The “good Germans” in WWII come to mind, although that’s an extreme example.
I’m not talking about injustice or suffering that happens at a far remove–there’s a limit to how many “causes” people can focus on or care about, and as Jon Stewart has put it, most of us “have shit to do.” I’m talking about the otherwise nice people who dismiss bullying at the local school with “boys will be boys,” who excuse brutality by the local police because “they” probably had it coming, who enthusiastically support draconian measures targeting immigrants, or who want to discontinue public welfare for poor people because “recipients are all lazy good-for-nothings.”
I guess I’m talking about people who are generally ready to help a fellow human–but who define “fellow human” to exclude a lot of people–people they would probably help if they lived next door.
Another election day has come and gone, and while I’ve grown leery of predicting anything in an era when crazy is the most prominent characteristic of our political environment, the results may justify a cautious optimism.
Despite the constant references to the “gay agenda,” anyone sentient has long recognized that the group having the real “agenda” has been the extreme religious right—and it’s an agenda that doesn’t have much place for anyone who isn’t one of them. It’s anti-gay, obviously, but it is also anti-immigrant, anti-woman, anti-freethought….pretty much anti-modernity, actually.
So it was heartening to see results from a referendum in Mississippi, of all places, where the usual subjects were promoting a measure that would have given “personhood” to fertilized eggs—thus outlawing not only abortion, but several methods of birth control. This proved to be a bridge too far even for Mississippi voters, who are not generally considered pinko/socialist/liberal types.
It was also gratifying to see the recall of the Arizona State Senator who had spearheaded that state’s mean-spirited and draconian anti-immigration frenzy. There are legitimate arguments to made about immigration policy, but these sorts of punitive efforts are clearly based upon animosity toward people who “don’t look like us.” (As I have often noted, my own son-in-law is an immigrant who has been in the US for 30 years, and has never encountered any anti-immigrant sentiment. He’s never been asked whether he’s here legally. It’s hard not to attribute that to the fact that he’s a very fair-skinned white guy from England, with a cute British accent, rather than a brown-skinned person with a Spanish accent. But the anti-immigrant movement is all about the rule of law—not bigotry. Right?)
In Ohio, voters overwhelming rejected a mean-spirited effort to punish teachers, firefighters and other public employees for the perceived transgressions of “big” government.
And here in my hometown, we achieved a milestone of sorts with the election of an openly-gay candidate to the City-County Council.
Not only did Zach Adamson, the candidate in question, win election easily, his orientation never became an issue—not overtly, not covertly. If there was any sort of “whisper” campaign, the whisper was so soft no one heard it. Zach ran a close third among the four Democratic at-large candidates (and third among all ten running at large), and focused his campaign upon the issues most important to voters: infrastructure, business climate and other matters with which a municipal government must deal. He stressed his experience as a small business owner, and treated his orientation in the same matter-of-fact fashion he treated everything else. His partner was visible and involved.
Little by little, gay and lesbian candidates around the country have been running similar campaigns—not hiding their homosexuality, but placing sexual orientation in the same context that heterosexual candidates do. It’s one more piece of information about a particular, complex human being. Increasingly, out gay candidates are winning elective office—not just on the coasts, but in places like Indiana and even Texas, where Annise Parker, an out lesbian, just won her second term as Mayor. (Her campaign was successful despite significant anti-gay activity, however; here in Indianapolis, as I noted above, there was no such activity evident.)
I’d love to believe that these elections were a harbinger of a return to collective sanity, but I allowed myself to believe that in the wake of Obama’s victory and I’ve been forcibly reminded otherwise. On the other hand, it’s hard not to see the vicious backlash against Obama as the last gasp of people who “want their country back”—whether they are reacting against an African-American President or simply against the rapidity of social change. The November elections seem qualitatively different, and for that reason more promising.
