Commentary on Policy and Politics–which includes pretty much everything
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.
The recent shutdown of the federal government got me
thinking again about something that has been on and off my mind for about 20
years, the state of government workers.
I started thinking about this one day in a class I was
teaching and it dawned on me that the students sitting in front of me had never
been alive when attacking government wasn’t the predominate mode. They were
raised in an era, as Ronald Reagan put it, not only was government not the answer,
but it was the problem. While it is possible that they grew up in houses that
offered a broader view, it is impossible to escape the society-wide attitude
that, even at its best, there is something suspect about government. (My niece recounts
a classmate at the Kennedy School saying in class: “Private industry is always
more efficient than government. Everybody knows that.”)
The government shutdown got me thinking again about the
longer-term problems of this attitude. This is the first of three posts on the
topic of government workers and the broader society.
Inevitably, people are starting to talk about 2020.
Many people I know—which is to say older people who will
under absolutely no circumstances vote for Trump—are worrying that the
Democrats are tending too far left. My advice: “Chill out!’ And It’s not just that
this is all ridiculously far-way—although it is. Unless the Democrats lose
their collective mind, I am not worried by this.
I consider myself progressive, but more of a gradualist. I supported
Clinton over Sanders. I have many concerns about the policies proposed by those
further to the left. But so what? As economist Brad DeLong points out (in a
interview by Zack Beauchamp, strongly recommended): “The
baton rightly passes to our colleagues on our left. We are still here, but it
is not our time to lead.”
I recently attended a summit of groups working on reducing
gun violence in Illinois. Much of what was said underlined that we know ways to
reduce gun violence without unduly limiting civil liberties. The problem is
that, as a society, we are not willing to do what it takes. The majority of
society, and certainly most readers of this blog, disagree that the loss of thousands
of extra lives a year is an acceptable price to pay for relatively uncontrolled
access to guns. But they haven’t yet expressed this belief so strongly that
politicians feel no choice but to change their calculations. That may be
coming, but it is not here yet.
In any event, that is old news and this blog will focus on a
few other things from this meeting.
Five weeks ago there was another
scientific study that said the condition of the ocean was even worse than
imagined and that, really, we better start thinking about what we are going to
One of my recent posts was about more speculative societal
risk. Environmental risks are relatively immediate and are potentially
existential. But, while a large percentage of Americans recognize it’s a
problem, the political momentum to address the issue is not remotely
commensurate with the degree of societal risk. How can this be?
What does China have to do with the shutdown? Not much. But it helps put the shutdown in
The day before the partial government shutdown, the Dow
Jones average stood at 22,445. The day before the shutdown unexpectedly ended,
it closed at 24,576, a gain of about 9.5% in a little over a month. How could
the Market gain that much when most of the American government was shut-down
with who knows what damage to the American economy?
I certainly don’t know the whole answer, but to the extent
the people who write on the financial news pages know the answer, there seems
to be one over-riding issue: How are
tariff negotiations going with China? When there was good news about the
discussions, the Market jumped; when bad rumors were in the ascendency, the
Market tanked. (If you don’t believe me, simply Google “China negotiations and
stock market” For a tiny sample of up, see Fox
Business news on January 18; for down,
see a January 2 Reuters
A few months back, while reading the book Fly Girls, about early women aviators, I
was struck by how insanely dangerous early airplanes were. They fell out of the
sky quite regularly and a remarkable percentage of the early aviators died in
crashes. It got me wondering, anachronistically, how the development of
airplanes would happen in today’s more risk-averse world. I found that same
sentiment in a complaint voiced by a
Silicon Valley developer that achieving self-driving cars was being impeded
by the unwillingness of society to tolerate the trial and error necessary to make
autonomous vehicles a functioning reality. This is a fair comment, although it
doesn’t address that the early fliers almost exclusively killed themselves;
when autonomous vehicles run amok, it is unsuspecting bystanders who bear the
brunt. Nevertheless, this raises the broader issue of how much risk (and for
whom) is society willing to incur for technological progress.
Just before the election, a crew delivering cabinets to our next door neighbor sheared off a sprinkler head in the hall. It responded as sprinklers are designed to do. Fifteen units were affected and total damage will be between one quarter and one half million dollars. We spent a lot of the next two months living in hotels, dealing with insurance, and working with and around demolition and construction crews.
It got me thinking about the ways our society had changed
over the years. As folks have moved closer and closer to each other, stacked on
top of each other in our case, much of our daily lives are interconnected in qualitatively
different ways from our ancestors. Population density and technology are locked
in a symbiotic relationship— technology thrives on density and density breeds
technology. The result intertwines people in ways never previously imagined.