The Ups and Downs of Government Functioning

By Mike Koetting May 24, 2021

At the moment, it seems Michael Lewis is everywhere, pitching his new book, Premonition. His general theme is that, in addition to whatever specific depredations the Trump administration committed, there were deep government failures that made the pandemic response worse. The specific culprit in his book was the CDC, which made multiple errors and missed critical signals. Lewis sees this more as an example of how American government is subject to functional failures at critical points than a singular failing.

This touches a nerve. I believe in government, especially as compared to the limits of private enterprise. Government does a lot of things very well—and fairly. Medicare hums, airplanes zip around the country without smashing into each other, and we take clean water for granted.

But for a while now I have been troubled by a growing sense of governmental sclerosis around the edges, particularly when quick response is necessary. I don’t think this means we need less government. I do, however, believe we need to put real effort into making government work better.

Today’s post will offer a high-level context for the problems. A subsequent post will consider solutions, although—spoiler alert—it’s not like there is an easy or obvious way to eliminate these concerns. That is because the underlying issue is that the exercise of democratic values does not always point the way to effective action.

It is worth reiterating, however, that the exercise of democratic values is exactly why I think government solutions are so important. I am always concerned when people propose private enterprise as a fix-all approach. Private enterprise can be more efficient, but it typically creates efficiency by narrowing objectives. That is not an option available to democratic governments. When I hear someone talk about making government work like business, I know they don’t know how government works, what it is for, or both.

Democratic governing assumes that the bureaucracy can implement effectively in a value-neutral way whatever policy the political process produces. (In America, we complicate the process since we don’t really trust either politicians or bureaucrats. So we limit the politicians’ ability to control bureaucrats but also limit the bureaucracy’s ability to operate on its own, typically by making many positions political appointees, at the federal level, or electing many functional positions, at the state and local level.)

In any event, the emphasis in all democracies is on shaping policy. It is not surprising that people focus on the apparently higher order problem of creating policy since policies reflect the ideology that drives people into the governing process to begin with. People run for office so they can pass laws and determine policy. And, presumably, people get elected because of democratic support for their policies. I can’t ever remember someone running on a platform of not changing any policy, just implementing the existing policies better.

Accordingly, adopting new policies is a reflection of the democratic impulse. Moreover, a democratic government in a changing world will want to change policies in responses to shifts in circumstances.

But implementation is what determines how policy actually impacts people. Over many years I have challenged various journalists to pick at random a handful laws that were passed in the previous legislative session and follow up on how they have been implemented. I’ve never had a taker. Inevitably, the media considers implementation only when there has been a particular problem or it has simply taken longer than anticipated. This contributes to an exaggerated sense of how much problem government does have implementing policies and insufficient attention to what are the underlying challenges, and successes, of implementation.

But so much emphasis on making policy sometimes misses the point that carrying out policy is by no means simple, let alone automatic. There is also a problem that policies accrete and the cumulative impact is greater than individual policies would suggest.

Executing Policy Is Not Automatic

Simply being able to articulate a policy is a necessary, but by no means sufficient, condition to implement a policy. Even the simplest policies raise all kinds questions. Complicated policies more so. If the policy is politically contentious, implementation is even more difficult–and given the diversity of possible interest groups and the degree of political polarization, it seems almost anything can be contentious.

Civil servants are supposed to be able to deal with the issues of implementation. And, for the most part, they do, often performing admirably. But they face a host of obstacle including failure to invest in institutional infrastructure or in personnel; failure to allocate ample time or resources for implementation; failure to build review and revision into the basic structure; and changing directions before an implementation can mature.

The point here is not simply that implementing policy is difficult. It is that a democratic political system by its nature is so focused on setting policy that it often fails to give sufficient attention to the circumstances that contribute to successful implementation. These typically require longer-term consistency of purpose, leadership continuity, sufficient organizational slack to absorb surprises, and latitude for some degree of risk taking.

Compare these needed attributes to the reality of governmental agencies where directors are installed—often with mandates to create radical changes—anticipating short tenure, having to run a gauntlet to fill out their team, inheriting systems which might be old and designed for other policies, being subject to some degree of legislative oversight (and budget) that might not be consistent with their highest priorities, and subject to infinite recriminations for virtually any misstep.

You can see why this might be challenging.

Policy Accretion

When new policies are put in motion, they sometimes explicitly modify previous policy, a modification that may be more or less seamless. More often, the new policy is simply expected to coexist with existing policies. In either case, it’s not typically that the remaining policies flatly contradict one another. But it is often the case that navigating among the various policies simply makes things difficult. When I worked for the State of Illinois, 157 discrete steps were required to let a contract. Most of these stemmed from some plausible objective or to safeguard against some possible pitfall. But each had to be met and all, in turn, required oversight and reporting to oversight agencies, each protective of its particular policy purview. And, lurking in the background, were people ready to pounce on any transgression.

Another accretion versus implementation problem stems from the desire, itself sensible enough, to focus policies relatively narrowly. So agencies wind up with a patchwork quilt of nominally related policies that they have to make coherent. A small non-profit that my wife works with is dependent on government funding. But it must piece together multiple grant programs with different goals, different requirements around the services provided, shifting requirements from year to year, different very specific rules for handing individual expenses, different fiscal years, very limited ability to carry funds forward, and none of the funders willing to cover certain over-arching administrative expenses that are necessary for long run stability. The existence of so many specific requirements and the absences of policy that creates space for broader decision-making can make dealing with government exceptionally painful.

Each of these policies viewed in isolation makes sense. Indeed, many of them are in some degree necessary to achieve objectives that are positive goods. Affirmative action, privacy concerns, transparency requirements, fair work rules or environmental cautions are all things we rightfully expect government to look out for. But when they are amalgamated, effective action requires herculean efforts.


The above is by no means an all-purpose excuse for sluggish performance by government. Government, at all levels, is obligated to work at improving implementation. My next post will consider some potential steps that could improve government performance. However, the above suggests it will not be easy, nor should one be unrealistic about the likely outcome. If I am right, a big part of the problem is built into the fundamentals of our democratic government. In general, I think that’s a worthwhile trade-off. But that is no reason to give up mitigating what can be mitigated.

Author: mkbhhw

Mike Koetting’s career has been in health care policy and administration. But it has always been on the fringes of politics. His first job out of graduate school was conducting an evaluation of the Illinois Medicaid program for the Illinois Legislative Budget Office. In the following 40 years, he has been a health care provider, a researcher, a teacher, a regulator, a consultant and a payor. The biggest part of his career was 24 years as Vice President of Planning for the University of Chicago Medical Center. He retired from there in 2008, but in 2010 was asked to implement the ACA Medicaid expansion in Illinois, which kept him busy for another 5 years.

One thought on “The Ups and Downs of Government Functioning”

  1. Ah, “change” vs. “implement” policy. A very important distinction. Great job pointing this out, Mike: good dog!
    – kev


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