Sunday, October 21, 2012

Funding Government Services Positively



The problem:  Government departments are assigned problems that are chronic if not impossible, then given financial dis-incentives to solve them.  They need objectives that are  positively stated and positively rewarded.

Most of the goods and services we pursue have attracted private funding.  Invent a truly better mousetrap and it will attract funders manufacturers, marketers and be assigned floorspace in the store.  Unfortunately some service needs are broadly shared and do not attract capital.  By default we hand these service needs over to government.  Capital will fund well-drilling but only under monopoly circumstances would they fund water mains. When given a monopoly they behave and are regulated much like government.  

Similarly it is easy to find people to catch and sell fish but difficult to keep fishermen from over fishing or from selling contaminated fish, we hire government to do that less rewarding part of the job. Some services exist because of our social conscience.  Tribal people have equal access to the care of healers, in a totally capitalistic services the wealthy can get private flights to the Mayo clinic while the poor can be left to be sick in the streets. In this case we take a marketable service and hand it off to government in order that we may believe we have equal access to health.  We are still left with the mystery of how to fund it effectively without bureaucratic inefficiencies.

Government typically takes on these activities with fanfare and optimisim, and then finds it either can’t  meet demand  when the service is popular, or be successful when the service is unpopular. Police regulation of common recreational drugs is so unpopular that illegal demand is stimulated thus guaranteeing defeat of the effort.   

The US war on drugs is a good case in point to demonstrate government funding for an unpopular issue.   It has been rated as the top agricultural crop in the US rated at $23.3 billion compared to $7.5 billion for wheat.   That means that pot is more popular than bread, what hope is there of stamping it out?
A New York Times article says that over the last 10 years the US has spent $20 billion to $25 billion a year on counternarcotics efforts.  They note that the price of Cocaine is actually dropping which suggests the drug war in that case is failing despite the huge expenditures.
In the face of extreme difficulty in delivering a mandated service,  a government bureaucracy has only three choices; to admit failure,  suggest more study, or recommend more public money to increase the effort.    The latter has most always been the case, and  that is why the war on drugs becomes more expensive and the solution retreats farther in the distance, Medicare costs expand, more police area hired and crime is not substantially been reduced.  

The solution:  Restructure government services so that goals can be realized in positive measurable ways so that incentives can be offered and job security strengthened.

For example, why not decriminalize light drugs, tax the sale, and fund government on an incentive program based on reduced consumption.  If the public buys less drugs, the applicable departments are rewarded on an incentive program.  This might mean having some employees with less to do, but what a blessing to be relieved of the huge misery we have due to the current abuse of drugs.  


In a similar but less obvious way why don’t we provide the police departments incentive funding for statistically reducing speed deaths on the road?    Instead of putting up speed traps on long straight stretchers of highway on sunny days, they would be doing so in high-risk zones for accidents during high-risk periods and weather conditions.   Taking this farther for the police, why not  provide bonus funds for a statistical decrease in the most serious crime figures?  Fund them for making our streets statistically safer to walk on during evening hours.

A federal government minister told me that such a process would face the ire of unions who don’t want to work on reducing the employment of their members.    Government must make as its core objective to improve performance, not reduce employment. This might mean retraining employees,  but employees that know that job security is  not threatened will respond the way free enterprise workers do, by improving performance.  Drywallers know that if they work faster they increase earnings and get more jobs.   If government workers had similar  obvious and positive objectives they would be just as positively motivated to achieve success.

Medical services need this particular overhaul more than any other service.  Doctors and hospitals are funded for combating disease; they should be funded instead for producing wellness. Suppose every medical clinic were surveyed for the health of their client base in terms of cholesterol levels, obesity,  pulse levels, body muscle density,  blood pressure, etc. This measurement would produce a health index figure that would be adjusted for age.   If the health index improves, the clinic gets funded at a higher level.    

Current funding is based on number of patients and number of treatments, which results in a revolving door system where patients see their doctor frequently for very brief periods of time.

One doctor told me that if such health-indexed funding were in place he would have his staff organize exercise groups, groups to promote good eating, to combat health-damaging activities, and so on. 
Doctors would no longer be tempted to schedule endless tests and medications unless they had reason to believe the overall health of the patient would be enhanced.

The process could expand throughout government.   Why not fund social services for the abuse that does not occur, for alcohol and drug addiction reduction,  and for reduction in anti-social behaviors?  Why not fund the fisheries department more when fish repopulate streams,  and fund hydro services more when electrical surpluses were achieved?