Tag Archives: efficiency

Doonesbury Understands What MAGA Doesn’t…

I tried to reproduce last Sunday’s Doonesbury cartoon in lieu of today’s post, but my digital skills weren’t up to the task, so I will have to describe and discuss it instead.

The comic strip’s radio personality, Mark, gets a call from Al Gore. The conversation focuses on what Mark says was Gore’s “jam”–government efficiency. Gore explains that it had indeed been his “job one” as Vice President, and that in the space of seven years that effort had reduced the federal workforce by 426,000 workers, consolidated 800 agencies and eliminated 640,000 pages of rules.

When Mark says “Wait. Why didn’t I know any of that,” Gore responds “You didn’t notice because the process was carefully planned and responsibly executed. It never disrupted essential public services. Compare that to now.”

As I read that comic strip, I didn’t know whether to laugh or cry. (Okay, I did both.)

In just a few panels, Gary Trudeau made an essential point: if your intent was really to improve service delivery, to root out fraud and waste (and in most bureaucracies, very much including government, waste is a far more prevalent problem than intentional fraud), you would go about that task carefully. Responsibly. You wouldn’t approach it with what Paul Krugman has aptly called a group of Dunning-Kruger interns and a meat-ax.

You would take the time to determine what each agency did, and take care not to lose valuable institutional knowledge with your layoffs and firings–especially when that knowledge was essential to the management of things like atomic weaponry. You would learn the vagaries of government’s (frequently antiquated) digital systems, and avoid jumping to incorrect conclusions, avoiding ludicrous and easily debunked assertions that millions of dead Americans are receiving Social Security checks.

It has become abundantly clear that Musk’s manic exhibit with a chain-saw was a perfect representation of his real motive: to destroy the federal government–what the Rightwing crazies call their war against “the administrative state.”

I think there are two distinct reasons for pursuing that destruction, although they are not mutually exclusive. (Musk rather obviously falls into both categories.)

One motivation for the chain-saw approach is the naive and increasingly divorced from reality belief that we don’t really need government, except perhaps to maintain law and order. All those regulations that–among other things– keep your groceries safe to eat, prevent your bank from ripping you off and keep your airplane from crashing, and all those silly programs that do things like feed schoolchildren and support cancer research–and especially all those intrusive rules that prevent you from discriminating against people who have different skin colors, genders or religions–all of that activity is an unnecessary intrusion on your individual rights.

Once Musk bought Twitter and turned it into the cesspool of bigotry and ignorance that is now called X, his belief that government should operate minimally– and only for the benefit of rich White men– became clear. (As if we’d failed to notice..)

The second motivation is greed. We’ve seen the billionaires “bend the knee” to an administration that is hell-bent on destroying the economic system that facilitated their acquisition of wealth, evidently in the belief that when markets crash and they are free of regulations and that pesky rule of law, they will be in a position to buy low. (Their accompanying belief that they will be able to sell high after a time, however, is fatally flawed–stock values are unlikely to rebound in the absence of a stable democratic society, just as America’s reputation as a reliable ally is unlikely to recover in our lifetimes, if ever.)

Sometimes, uncomfortable truths are better conveyed by humor than by the efforts of would-be pundits writing blogs like this one. People of a certain age still quote a very famous Pogo strip for an essential insight: We have met the enemy and he is us.

The question we are now facing is: how many of us are willing to confront that particular insight? How many of us are willing to accept the unavoidable inefficiencies and annoyances that come with a government able to serve us all–and to fight for its preservation?

I guess we’ll find out…..

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Straight Talk About Government Efficiency

We can only speculate about the real motives prompting Trump/Musk to take a hatchet to the federal government. That motive is clearly not efficiency–indeed, in any logical world, it would be universally seen as insane, as would the betrayal of Ukraine, which undermines America’s global interests. (That betrayal is more than likely prompted by Trump’s continuing anger over Zelensky’s prior refusal to be blackmailed into accusing Joe Biden of invented crimes. Trump holds grudges.)

As I’ve watched Musk’s illegal DOGE wreak havoc with the federal government and put millions of Americans at risk, I revisited an article from Governing published just before that “department” began it’s slash and burn operations. The author,  who had participated in several state-level efforts to root out “fraud and waste,” noted that there are proper–and improper– ways to go about that task.

Before sharing the persuasive insights of that article, however, I want to point to a truly foundational issue–one that has become far more evident as DOGE continues its destructive path through our federal government. Most Americans reject what we now understand to be Musk’s definition of “fraud and waste.” Anyone who thinks that Social Security is a “Ponzi scheme” is clearly incapable of providing an evidence-based definition of either fraud or waste. (Evidently, to Musk, if a government program benefits millions of Americans–or if an agency’s operations interfere with the ability of Musk’s businesses to rip off taxpayers–that function is wasteful, if not fraudulent…)

The linked article begins by agreeing that efforts to streamline government and root out inefficiencies are always appropriate. It then points to some pesky facts about federal expenditures–facts that should guide any legitimate efforts.

Musk and Ramaswamy have promised a 30 percent cut in the federal government. Roughly 60 percent or so of federal spending, however, consists of interest payments on the national debt, Social Security, Medicare and national defense — largely (though not entirely) untouchable. The projected savings therefore purport to come mostly from wiping out everything else: cutting government regulation, eliminating large numbers of government programs and firing even larger numbers of employees.

Gutting regulation does little to reduce government spending, however, while employee compensation makes up only 4 percent of the federal budget. Firing every single federal employee would barely make a ripple. Whatever the merits of all this as policy, in reality it has little to do with efficiency.

In fact, in many ways, the proposed DOGE approach illustrates how not to pursue actual efficiency in government.

The author then suggests realistic ways to make government more efficient.

Be honest and realistic. Thirty years ago, the massive National Performance Review produced recommendations shaving nearly 7 percent off federal operations… it’s possible to reduce spending by as much as 10 percent annually — although not without severe political repercussions.

The “annually recurring” part is important. It’s easy to fake savings through accounting gimmicks and one-time asset sales. Sure, you can close a budget hole by raiding dedicated funds, postponing needed infrastructure repairs or construction, or even doing a sale-leaseback of the state capitol…  Real, meaningful “efficiency” recurs year after year. In fact, so should the search for efficiency.

It would be easy to cut government spending by 30 percent by eliminating all health and welfare spending. That may be the goal under DOGE. Unfortunately, about six months later, emergency rooms will be crammed, hospital systems will be incurring massive debts through charity care, workforce productivity will plummet, and communicable diseases will proliferate. Cutting just to cut generally costs more in the long term.

 Very little government spending consists of actual fraud and abuse, and less still by beneficiaries filing claims for, say, medical care they never received. It is mostly committed, rather, by providers seeking reimbursements for care they never delivered, or by big-dollar private contractors (particularly in defense: know anyone who fits that description?).

Sometimes, spending saves money. That may sound counterintuitive, but you wouldn’t fire your accounts receivable department, would you? Hiring more revenue collectors is good “business,” even in government.

The author noted that the best way to save money is by improving service delivery, not performative gestures like slashing huge programs. Cutting inefficiency doesn’t require attacking the people who carry out the processes — it requires streamlining the processes themselves.

And rather than firing staff, if we really wanted to find ways to eliminate waste and inefficiency, we would ask the people who work for government–because those are the folks who actually know. “That’s how leaders, public or private, proceed if they’re serious about making their operations work better.”

But of course, making government work better is the farthest thing from Trump/Musk’s mind. They just want it to work better for them.

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Up Close and Personal with the NHS

We had our first (only) encounter with Britain’s National Health Service yesterday.

Bob’s cough kept getting worse, despite the cough medicines and lozenges, and our granddaughter and her partner suggested we take him to one of the NHS’ Walk-In facilities. There were two nearby (we walked from our hotel).

When we got there, we took a number from a dispenser and sat in the waiting room. The system was that the people at the desk would call a number, and you would then register, explain what was wrong, etc., and wait to be called back to be seen. Our number was called almost immediately; when we described the problem, the very nice woman behind the desk put a monitor on Bob’s finger, pronounced his oxygen levels low, and said she was putting him at the “head of the queue.” (She also said that she very much regretted that she would have to charge us for service since we weren’t British. The cost was fifty pounds.)

Bob was called back within ten minutes to see a nurse practitioner. She took a history, examined him, and called an ambulance to take him to Nottingham University’s hospital. She said she might be “over-reacting a bit–I hope so” but “better safe than sorry.” The ambulance drivers were there almost immediately, and I went with him in the ambulance while our granddaughter and her partner drove separately. I can’t say enough about how efficient and caring the EMTs in the ambulance were. They were also very proud of the vehicle itself, which they explained was new, and certainly looked well-equipped to my untrained eye.

We were taken to emergency (they call it A and E, for Accident and Emergency). Again, we were impressed with the efficiency of the process; first, an evaluation and a number of lab tests, then further tests based upon the initial results. Throughout the (very long) day, personnel kept us informed of where we were in the process, why they were doing what they were doing, etc.

The concern was that he was having a pulmonary embolism. Thankfully, the scans ruled that out; however, what we thought was a bad cold (and what the ship’s doctor had shrugged off as a cold or allergy) turned out to be a heart problem that has evidently been developing for some time and had not been detected by his cardiologist on his visit a week before our trip. The doctor explained that his symptoms were the result of fluid accumulation–probably the result of unusual activity on the trip. He was admitted for a short stay so that they can eliminate the additional fluid and he can safely fly home. (Only then were we asked whether we had insurance; a nurse took our information and nothing more was said about payment.)

To say that we had a stressful day would be an understatement. I extended our hotel booking in Nottingham and my son managed to change our flight home from tomorrow to Saturday (unfortunately, we lost those first-class seats we’d used our frequent-flyer miles to secure..).  My granddaughter and her wonderful partner pretty much saved what sanity I managed to retain. So at this point at least, it looks to be an “all’s well that ends not so badly” situation.

When you live with an 80-year-old husband with heart problems, you see the inside of a lot of emergency rooms and hospitals. I don’t know whether my experience yesterday was representative, but I was very impressed with the efficiency and thoroughness with which Bob was treated. There were adequate numbers of personnel, and they were unfailingly pleasant and responsive. Our waits were for lab results. Doctors and nurses took time to ask questions and listen carefully…I really could not have asked for better or more reassuring care.

The systemic differences between my previous experiences at home and here really boiled down to two: 1) The clinic and hospital were both in old buildings and certainly didn’t have the physical amenities/decor of most American hospitals. They were clean and well-equipped, but not the sort of plush environments we generally encounter in the U.S.  2) At home, unless he was having a heart attack, treatment wouldn’t have commenced until payment had been arranged–I always check him in by providing insurance information, etc.

As academics like to say, anecdotes aren’t data. But my anecdote says lots of good things about the NHS.

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