Mass testing for the coronavirus and the crisis of public management
I worked in the federal government at the start of my career and when I left the government, I started teaching about public management to public administration students. I had been frustrated by the ineffectiveness of the federal government and wanted to train aspiring public managers to do a better job. In 1988, I wrote my first book, titled "The Effective Public Manager," and along with people like David Osborne who wrote "Reinventing Government," and scholars such as Lawrence Lynn, Steve Kelman, Robert Behn, Fred Thompson, Bill Eimicke, Tanya Heikkila and many others started to work on methods to improve government management. We did not see government as a problem the way Ronald Reagan did, but we saw government as red-tape laden, out-of-date, unresponsive and slow to change. The goal was to improve government management, not destroy government.
Unfortunately, we ran into the buzz saw of ideology and for decades, federal public administration has been starved of resources, energy and talent. Many of us stopped paying attention to the worst government bureaucracy, the one in Washington, and focused on local government and public-private partnerships. As the private sector replaced vertically integrated organizational hierarchies with global networks and supply chains, we started to imitate those tendencies in the public sector. Unfortunately, too often a public organization's decision about whether to make something or buy something was not a management decision, but a decision determined by interest groups, political corruption or ideology. Some functions that shouldn't be contracted out have been outsourced and some that should be done elsewhere remained in-house. Over the past four decades, we have seen an overall decline in governmental effectiveness due to ideology and disinvestment at the same time we've seen technology transform organizational effectiveness everywhere else. If you think I'm wrong, remember the Obamacare website fiasco or try to sign up for unemployment insurance today. The pathetic federal response to the Coronavirus is the result of four decades of government's declining organizational capacity.
In the midst of this global pandemic, I can't help but see the development and response to this crisis as a massive failure of governmental effectiveness. The principal function of government is to protect us, and one must conclude that government has failed to defend us from this pandemic. Medical experts in China and the United States were ignored by governmental decision-makers. Wishful thinking and gut feelings substituted for science, data and models. And now the global economy is in free fall and no one can move about freely in any public spaces anywhere. In New York City, the public's fear of this disease has managed to reduce it's spread and prevented the city's hospitals from melting down. In New York, our state and local government's late but strong messages and urgent preparations for expanding health care demonstrated the capacity for government action and effectiveness during a catastrophe. But state governments require massive federal assistance and coordination if we are to reopen our cities and businesses.
The challenge now is to mobilize the testing and other resources needed to reopen the economy. It is clear today, as it was during the massive crash program to arm the nation during World War II, that in America, this will require a partnership between the public and private sectors. This is not a new story, but it does not seem to be particularly well understood by this president. Directing the private sector to produce something during a national emergency is not communism. The private firm makes money on the deal and eventually (at public cost) converts back to pre-emergency production. At this point in the Coronavirus, the chief challenge to government is to quickly make hundreds of millions of virus tests freely available throughout society. If we developed the capacity for massive and rapid testing, hundreds of millions of us could be tested regularly and if infected, isolated until we discover a way to prevent and treat this disease. A mobilization of all sectors of our economy by the federal government with the goal of mass testing could put this pandemic in the rearview mirror. The development and implementation of mass testing could be achieved by the world's most powerful nation if an organized and determined federal government made it the nation's single highest priority.
Unfortunately, the goal of mass testing can't be achieved as long as the people running the U.S. federal government are more interested in promoting their image and shifting blame than solving the testing problem. As Dan Frosch, Deanna Paul and Ian Lovett recently reported in the Wall Street Journal:
"A rapid test for the new coronavirus that was touted by the White House as a game-changing development has proved vexing for state officials, who say the federal government has failed to provide enough necessary equipment… After conducting a bulk purchase with Abbott, the federal government this month gave every state except Alaska 15 devices and 120 cartridges, regardless of its population or severity of its coronavirus outbreak… The frustration over how the Abbott tests are being doled out underscores the Trump administration's ongoing struggle to respond to national testing shortages. While more coronavirus tests have been made available in recent weeks, via private laboratories that now have FDA approval, results can take days. High-volume tests have been hampered by inaccurate results, delays and technical problems."
The problem is not simply in the White House. The Food and Drug Administration was slow and incompetent in its initial effort to review and approve new tests of the virus. The federal agencies engaged in implementing the two trillion-dollar stimulus seem unable to figure out how to get money into anyone's bank accounts. American farmers are destroying crops that couldn't be sold to closed restaurants and schools but could have been purchased by the federal government to give to hungry Americans. Part of the problem is that political dysfunction leads to unimplementable policy designs. Another part of the problem is the hollowing out of capacity in the federal government. The best and the brightest are working elsewhere, and the morale of the remaining public administrators is at an all-time low.
Public policy and economic life are far more complicated today than during the New Deal and World War II. With the public sector more outsourced, the role of private and nonprofit organizations has become more central to the implementation of public policy. For that reason, the new management book that Bill Eimicke and I recently wrote and will soon be published by Columbia University Press addresses organizational management in all sectors and is entitled Management Fundamentals. While each sector is unique, we have come to the conclusion that the fundamental factors influencing organizational effectiveness are the same across all sectors. We also believe that public and private managers need to learn more about the organizational dynamics constraining and influencing the behavior of their partners and colleagues across each sector.
The private sector is now embedded in the implementation of public policy. The manufacturers of ventilators, virus tests and personal protective equipment are private organizations. Most hospitals are private, nonprofit organizations. Making public policy real in the 21st century cannot be accomplished without private organizations. Government regulators must understand private management imperatives and private sector CEOs must learn to respect and serve the public interest along with their private interest.
The big shots that run this place should take a cue from the society they are trying to lead. In the statistical models built to predict New York's pandemic, the hospitalization and death rates assumed that many New Yorkers would ignore the call for social distancing. The models were wrong. People are scared, but also civic-minded. Yes, they are afraid of being sick. But they also did not want to make their parents sick. Today, when New Yorkers walk in the park, they pay attention and work hard to stay six feet apart. Civic virtue is not dead in America, now it needs to be brought back to the board room, the Situation Room and the halls of Congress. The crisis of public management cannot be addressed without resources, determination, strategy, focus and goodwill. We need to learn how to work together again as an American community. The alternative is to die alone while clinging to our ideologies and sense of moral superiority.
This story is republished courtesy of Earth Institute, Columbia University http://blogs.ei.columbia.edu.
