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Destroying trust in the media, science, and government has left America vulnerable to disaster

For America to minimize the damage from the current pandemic, the media must inform, science must innovate, and our government must administer like never before. Yet decades of politically-motivated attacks discrediting all three institutions, taken to a new level by President Trump, leave the American public in a vulnerable position. Trump has consistently vilified the…

       




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Multinational corporations in a changing global economy: Opportunities and challenges for workers, firms, communities and governments

As policymakers in the United States consider strategies to stimulate economic growth, bolster employment and wages, reduce inequality, and stabilize federal government finances, many express concerns about the role of US multinational corporations and globalization more generally.  Despite a significant body of work, the research community cannot yet fully explain and coherently articulate the roles…

       




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Tackling the Mortgage Crisis: 10 Action Steps for State Government

Introduction

During 2006, the United States saw a considerable upswing in the number of new mortgage defaults and foreclosure filings. By 2007, that upswing had become a tidal wave. Today, national homeownership rates are falling, while more than a million American families have already lost their homes to foreclosure. Across the country, boarded houses are appearing on once stable blocks. Some of the hardest hit communities are in older industrial cities, particularly Midwestern cities such as Cleveland, Detroit, and Indianapolis.

Although most media attention has focused on the role of the federal government in stemming this crisis, states have the legal powers, financial resources, and political will to mitigate its impact. Some state governments have taken action, negotiating compacts with mortgage lenders, enacting state laws regulating mortgage lending, and creating so-called “rescue funds.” Governors such as Schwarzenegger in California, Strickland in Ohio, and Patrick in Massachusetts have taken the lead on this issue. State action so far, however, has just begun to address a still unfolding, multidimensional crisis. If the issue is to be addressed successfully and at least some of its damage mitigated, better designed, comprehensive strategies are needed.

This paper describes how state government can tackle both the immediate problems caused by the wave of mortgage foreclosures and prevent the same thing from happening again. After a short overview of the crisis and its effect on America’s towns and cities, the paper outlines options available to state government, and offers ten specific action steps, representing the most appropriate and potentially effective strategies available for coping with the varying dimensions of the problem.

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  • Alan Mallach
      
 
 




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Enterprise Leadership: The Essential Framework for Today’s Government Leaders

Government leaders increasingly face complex problems that demand collaborative interagency solutions. Almost all of the major challenges confronting government today – from cyber security and food safety to veterans' homelessness and global climate change – require leaders at all levels that can coordinate resources beyond their immediate control. A new compilation of essays, Tackling Wicked Government Problems:…

       




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Social Security coverage for state and local government workers: A reconsideration


Since it was created in 1935, Social Security has grown from covering about half of the work force to covering nearly all workers.  The largest remaining exempted group is a subset of state and local government workers (SLGWs).  As of 2008, Social Security did not cover about 27 percent of the 23.8 million SLGWs (Congressional Research Service 2011).  Non-coverage of SLGWs is concentrated in certain states scattered around the country and includes workers in a diverse set of jobs, ranging from administrators to custodial staff.  Some police and fire department employees are not covered.  About 40 percent of public school teachers are not covered by Social Security (Kan and Alderman 2014).    

Under current law, state and local governments that do not offer their own retirement plan must enroll their employees in Social Security.  But if it does offer a retirement plan, the state or local government can choose whether to enroll its workers in Social Security.  

This paper reviews and extends discussion on whether state and local government workers should face mandatory coverage in Social Security.[1]  Relative to earlier work, we focus on links between this issue and recent developments in state and local pensions.  Although some of the issues apply equally to both existing and newly hired SLGWs, it is most natural to focus on whether newly hired employees should be brought into Social Security.[2]  

The first thing to note about this topic is that it is purely a transitional issue.  If all SLGWs were already currently enrolled in Social Security, there would not be a serious discussion about whether they should be removed.  For example, there is no discussion of whether the existing three quarters of all SLGWs that are enrolled in Social Security should be removed from coverage.

Bringing state and local government workers into the system would allow Social Security to reach the goal of providing retirement security for all workers.  The effects on Social Security finances are mixed.  Bringing SLGWs into the system would also help shore up Social Security finances over the next few decades and, under common scoring methods, push the date of trust fund insolvency back by one year, but after that, the cost of increased benefit payments would offset those improvements. 

Mandatory coverage would also be fairer.  Other workers pay, via payroll taxes, the “legacy” costs associated with the creation of Social Security as a pay-as-you-go system.   Early generations of Social Security beneficiaries received far more in payouts than they contributed to the system and those net costs are now being paid by current and future generations.  There appears to be no convincing reason why certain state and local workers should be exempt from this societal obligation.  As a result of this fact and the short-term benefit to the program’s finances, most major proposals and commissions to reform Social Security and all commissions to shore up the long-term federal budget have included the idea of mandatory coverage of newly hired SLGWs.

While these issues are long-standing, recent developments concerning state and local pensions have raised the issue of mandatory coverage in a new light. Linking the funding status of state and local pension plans and the potential risk faced by those employees with the mandatory coverage question is a principal goal of this paper.  One factor is that many state and local government pension plans are facing significant underfunding of promised pension benefits.  In a few municipal bankruptcy cases, the reduction of promised benefits for both current employees and those who have already retired has been discussed.  The potential vulnerability of these benefits emphasizes the importance of Social Security coverage, and naturally invites a rethinking of whether newly hired SLGWs should be required to join the program.  On the other hand, the same pension funding problems imply that any policy that adds newly-hired workers to Social Security, and thus requires the state to pay its share of those contributions, would create added overall costs for state and local governments at a time when pension promises are already hard to meet.  The change might also divert a portion of existing employee or employer contributions to Social Security and away from the state pension program. 

We provide two key results linking state government pension funding status and SLGW coverage. First, we show that states with governmental pension plans that have greater levels of underfunding tend also to have a smaller proportion of SLGW workers that are covered by Social Security.  This tends to raise the retirement security risks faced by those workers and provides further fuel for mandatory coverage.  While one can debate whether future public pension commitments or future Social Security promises are more risky, a solution resulting in less of both is the worst possible outcome for the workers in question.  Second, we show that state pension benefit levels for career workers are somewhat compensatory, in that states with lower rates of Social Security coverage for SLGWs tend to have somewhat higher pension benefit levels.  The extent to which promised but underfunded benefits actually compensate for the higher risk to individual workers of non-Social Security coverage is an open question, though.  

Mandatory coverage of newly hired SLGWs could improve the security of their retirement benefits (by diversifying the sources of their retirement income), raise average benefit levels in many cases (even assuming significant changes in state and local government pensions in response to mandatory coverage), and would improve the quality of benefits received, including provisions for full inflation indexation, and dependent, survivor and disability benefits in Social Security that are superior to those in most state pension plans.  The ability to accrue and receive Social Security benefits would be particularly valuable for the many SLGWs who leave public service either without ever having been vested in a government pension or having been vested but not reaching the steep part of the benefit accrual path.  

Just as there is strong support for mandatory coverage in the Social Security community and literature, there is strong opposition to such a change in elements of the state and local government pension world.  The two groups that are most consistently and strongly opposed to mandatory coverage of newly hired SLGWs are the two parties most directly affected – state and local governments that do not already provide such coverage and their uncovered employees.  Opponents cite the higher cost to both employees and the state and local government for providing that coverage and the potential for losing currently promised pension benefits. They note that public pensions – unlike Social Security – can invest in risky assets and thus can provide better benefits at lower cost.  This, of course, is a best-case alternative as losses among those risky assets could also increase pressure on pension finances.

There is nothing inconsistent about the two sides of these arguments; one set tends to focus on benefits, the other on costs.  They can be, and probably are, all true simultaneously.  There is also a constitutional issue that used to hang over the whole debate – whether the federal government has the right to tax the states and local government units in their roles as employers – but that seems resolved at this point.

Section II of this paper discusses the history and current status of Social Security coverage for SLGWs.   Section III discusses mandatory coverage in the context of Social Security funding and the federal budget.  Section IV discusses the issues in the context of state and local budgets, existing pension plans, and the risks and benefits to employees of those governments.  Section V concludes.



[1] Earlier surveys of these issues provide excellent background.  See Government Accountability Office (1998), Munnell (2005), and Congressional Research Service (2011).

[2] A variety of related issues are beyond the scope of the paper, including in particular how best to close gaps between promised benefits and accruing assets in state and local pension plans and the level of those benefits.   


Note: A revised version of this paper is forthcoming in The Journal of Retirement.

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Public pensions in flux: Can the federal government's experiences inform state responses?


In many policy-related situations, the states can be useful laboratories to determine the most appropriate federal actions. Variations across states in health care programs, earned income credit rules, minimum wages, and other policies have helped inform debates about federal interventions.

In this paper, we reverse that approach. Many state and local governments currently face difficulties financing future pension obligations for their workers. The federal government, however, faced similar circumstances in the 1980s and successfully implemented a substantial reform. We examine the situation the federal government faced and how it responded to the funding challenge. We present key aspects of the situation facing state governments currently and draw comparisons between them and the federal situation in the 1980s. Our overarching conclusion is that states experiencing distress today about the cost and funding of its pension plans could benefit from following an approach similar to the federal government’s resolution of its pension problems in the 1980s.

The federal government retained the existing Civil Service Retirement System (CSRS) for existing employees and created a new Federal Employees’ Retirement System (FERS) for new employees. FERS combined a less generous defined benefit plan than CSRS, mandatory enrollment in Social Security, and a new defined contribution plan with extensive employer matching. Although we do not wish to imply that a “one size fits all” solution applies to the very diverse situations that different states face, we nonetheless conclude that the elements of durable, effective, and just reforms for state pension plans will likely include the major elements of the federal reform listed above.

Section II discusses the federal experience with pension reform. Section III discusses the status and recent developments regarding state and local pensions. Section IV discusses the similarities in the two situations and how policy changes structured along the lines of the federal reform could help state and local governments and their employees.

Download "Public Pensions in Flux: Can the Federal Government’s Experiences Inform State Responses?" »

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Image Source: © Max Whittaker / Reuters
      
 
 




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Webinar: How federal job vacancies hinder the government’s response to COVID-19

Vacant positions and high turnover across the federal bureaucracy have been a perpetual problem since President Trump was sworn into office. Upper-level Trump administration officials (“the A Team”) have experienced a turnover rate of 85 percent — much higher than any other administration in the past 40 years. The struggle to recruit and retain qualified…

       




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Webinar: How federal job vacancies hinder the government’s response to COVID-19

Vacant positions and high turnover across the federal bureaucracy have been a perpetual problem since President Trump was sworn into office. Upper-level Trump administration officials (“the A Team”) have experienced a turnover rate of 85 percent — much higher than any other administration in the past 40 years. The struggle to recruit and retain qualified…

       




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Traffic: Why It’s Getting Worse, What Government Can Do

Contents Introduction The Real Problem Coping With the Mobility Problem The Principle of Triple Convergence Triple Convergence and Other Proposals How Population Growth Can Swamp Transportation Capacity Low-Density Settlements Possible Improvements Conclusion Rising traffic congestion is an inescapable condition in large and growing metropolitan areas across the world, from Los Angeles to Tokyo, from Cairo…

       




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Online Campaigning Part 2: Governments Get Into Online Activism

“Pardon Edward Snowden.” “SOPHIES CHOICE, smear test lowered to 16.” These are the top petitions Americans and Britons are asking their respective governments on online petition platforms run by the White House and the U.K. Cabinet Office. So how does the world of online activism work when it comes to government-hosted petition sites? The U.K.…

       




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The gender and racial diversity of the federal government’s economists

The lack of diversity in the field of economics – in addition to the lack of progress relative to other STEM fields – is drawing increasing attention in the profession, but nearly all the focus has been on economists at academic institutions, and little attention has been devoted to the diversity of the economists employed…

       




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What is the role of government in a modern economy? The case of Australia


Australia's economic performance has been the standout among advanced economies for several decades. With economic growth at nearly twice the pace of US or Germany over the past decade, a remarkable 25 years without a recession and a large, highly competitive mining sector despite the end of the resources boom, Australia remains a strong economic participant in a region of the world where future global growth is likely to be generated.

But with drivers of growth over the past 25 years unlikely to be the engines of growth in coming decades, now is not a time for complacency. And if there's one lesson from Britain's decision to leave the EU, it's that that disruptive forces are sweeping through the global economy. Australia, with its cohesive politics and economic success, has been able to avoid the worst of these problems, but the dangers are present if the economic challenges are not met.

To start with, the impacts of the reforms of the 1980s and 1990s are fading. The investment boom in mining is over, and the prices for mining and agricultural exports will probably remain subdued with slower growth in China. While Australia's incomes were boosted by the improved terms of trade, this has partially reversed. The housing boom will inevitably eventually slow.

As evidenced by the results of the Brexit referendum, there is a distrust of the political and economic elites that have led the world's biggest economies. Disruptive, rapid changes in technology have not led to broad-based productivity growth. Workers in many countries have been left with stagnant incomes and governments with rising public debt.

Industry policy has a bad name among American economists who see it as a manifestation of "capture" where special interests are able to obtain subsidies from taxpayers or special protections that are not in the national interest. The modern theory of industry policy, however, recognises that a well-designed policy can actually help markets work better, therefore helping an economy like Australia's make the transition to a new growth path when faced with changing economic conditions. Productivity is the key to high growth and rising incomes – and well-designed industry policy can help.

Structure of trade competitiveness

Take, for example, Australia's manufacturing sector. Mostly because of comparative advantage, it is the smallest among all advanced economies relative to the size of its economy. In 2010, Germany had 21.2 per cent of its workforce in manufacturing while Australia's was 8.9 per cent. While it's not surprising that Australia's structure of trade competitiveness differs from Germany's because of its enormous export strength of mining and agriculture, it will benefit by taking advantage of its highly skilled workforce and the potential to develop industries based on this human capital – including advanced manufacturing industries.

One of the traditional strengths of the American economy is the close link that exists between leading universities and businesses – an area Australian policymakers are seeking to improve upon. At MIT and Stanford, professors of engineering, biology, finance or economics finish their lectures and head off to the companies they run or advise. They often enlist graduate or undergraduate students to help them with their commercial projects and these collaborations often result in jobs as well as experience. There is a danger in this model if pure research loses out to business interests, but the interaction between academia and the practical needs of companies can largely improve both research and business profitability. It's worth recalling that even the giants of science in the 18th century were motivated by the need to improve navigation or build new machines or design buildings. Funding for research should support greater industry-university cooperation as highlighted by the Watt Review.

Another important element in Australia's continued economic success is the growth of its service industries. With most jobs in these industries, the performance and productivity of services will be the largest determinant of Australia's living standards. Productivity comparisons between Australia and the United States show that Australian productivity lagged behind the US as recently as the mid-1990s, but there has since been substantial catch-up taking place. Smart regulation that promotes competition and rewards innovation are necessary to bring up the laggards. While there is a continuing debate about the possible end of productivity growth in advanced economies, Australia can still do much to catch up to global best practice.

The winners of this weekend's election will be charged with answering an important question: what is the role of government in a modern economy? How they answer that will determine future prosperity for all Australians.

High taxes, large government, poorly regulated markets (particularly labour markets), excessive debt and poor infrastructure undermine the drivers of growth. The realities of a fragile global economy and the need to build a solid foundation to generate productivity growth in Australia must be at the core of the policies that follow this election campaign.

Martin Baily is a senior fellow at the Brookings Institution in Washington and a former chair of the US President's Council of Economic Advisers. He has been invited by the Australian Ministry of Industry Innovation and Science to report on lessons from the US for policies to enhance economic growth, innovation and competitiveness.

Warwick McKibbin AO, is the director of the Centre for Applied Macroeconomic Analysis in the ANU Crawford School of Public Policy and is a non-resident senior fellow at the Brookings Institution.

Editor's note: this opinion first appeared in Australian Financial Review.

Publication: Australian Financial Review
      
 
 




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What’s the government done to relieve student loan borrowers of their burden during the corona crisis?

Forty-two million Americans, or one in every eight, have student loans, and they owe a total of $1.6 trillion, the second largest pool of consumer credit after mortgages. According to the Federal Reserve, 20 percent of adult borrowers who borrowed for their own educations were behind on their payments in 2018. Of those who are…

       




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But Will It Work?: Implementation Analysis to Improve Government Performance

Executive Summary Problems that arise in the implementation process make it less likely that policy objectives will be achieved in many government programs. Implementation problems may also damage the morale and external reputations of the agencies in charge of implementation. Although many implementation problems occur repeatedly across programs and can be predicted in advance, legislators…

       




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Why local governments should prepare for the fiscal effects of a dwindling coal industry

       




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The six keys to securing ethical government: A U.S. view


Editor's Note: On Thursday Brookings Visiting Fellow, Amb. Norm Eisen addressed the Italian Parliament to discuss ethics in government, highlighting efforts in the US to improve transparency and accountability. In the speech, Amb. Eisen argues that while ethics reform can be difficult, it is an absolutely essentially part of any democratic system.


As Prepared For Delivery

Signora Presidente Boldrini, Madam President Brasseur, honorevoli Parlamentari, fellow panelists and distinguished guests, buon pomerigo. Thanks for inviting me to address the urgent subject of ethical standards in political life. It is an honor to be here in the Italian Chamber of Deputies, in this beautiful and ancient city, to which we Americans owe so many elements of our system of government. And in my town of Washington, DC we also borrowed a lot of your architecture, so we owe you for that as well.

In exchange for all that, as a small form of repayment, I would like to offer some perspectives from the U.S. as you consider the adoption of a code of ethical conduct for the Italian Parliament.

Since we are in the Chamber of Deputies, the equivalent of our U.S. Congress’ House of Representatives, I will start with best practices in that body, based on years of my professional life—too many—spent addressing alleged violations of its codes of conduct, including as a defense lawyer and later as the co-founder of a government watchdog group.

And I think there are also important lessons to be drawn from the new, innovative code of conduct for White House officials we established while I served as the "Ethics Czar" of President Obama. At his direction I helped write that new code, the Obama "ethics pledge," and although I am biased I think it has been effective so far, knock wood, there have been no major White House scandals. So I will talk about the lessons of that code of conduct a bit as well. My reflections are those of a friend and partner nation with plenty of challenges of our own. So I approach the issue with genuine humility in sharing our successes and failures.

I. Government ethics while standing on one leg

So—what is our U.S. view of best practices for the contents of government codes of ethics? In the U.S. and dare I say internationally, there is a pretty well developed set of best practices. In our House of Representatives, for example, our equivalent of this Chamber of Deputies, Rule XXIII is the Code of Official Conduct. It provides rules in four core areas;

  • one, for regulating conflicts of interest, that is, situations where personal interests or financial holdings may conflict with official parliamentary duties;
  • two, for gifts, particularly those from lobbyists and other persons interested in parliamentary decisions;
  • three, for outside employment of parliamentarians before, during and after government service, particularly with lobbyists, a situation which we call in the US the revolving door; and
  • four, for parliamentarians’ proper use of official resources, that is, hiring, staff, budget, travel and such.

There is much more detail in our code of conduct, and a few other rules as well, but those four items—conflicts, gifts, employment and resources—are the key. These same four key areas are also at the center of our codes of conduct for employees of our executive branch, as codified in our statutes and regulations, as well as in the Obama ethics pledge.

I emphasize these four key items because, having helped draft one code of conduct, and having often delved into many other codes, I sometimes find that I lose the forest for the trees when working with these codes, that the priorities at least for me sometimes get lost in the detail. So I try to keep the core always in mind, though I should add that the content of any such code must of course be particularized for the circumstances of particular government bodies and jurisdictions. Thus our U.S. House code is five pages long, elaborating on those four core items, and the House Ethics Manual of official guidance for the code is 456 pages long. Our Obama ethics pledge we got onto one page, we were proud of that. And we made everyone read and sign that page. To be fair, we could do that because we built on and added to other rules which already existed, and we did have several pages of definitions and references attached to the pledge.

II. Enforcement and transparency

But a good code is only the beginning. In our U.S. experience, just as important as the code, maybe even more important, is its enforcement. And here is where I want to share some lessons drawn from U.S. challenges in recent years, and how we responded. I am going to add two more items to our check list: enforcement and transparency.

Candidly, even with our parliamentary code of conduct in the U.S., our enforcement has sometime lagged. That is in part because under our Constitution, the ultimate enforcers are the parliamentarians themselves, and so they can at times be understandably reluctant to sanction their colleagues and friends. It's human nature.

For example, from about 1998 to 2004, there was a seven-year truce in filing complaints in our House of Representatives. The government watchdog organization I co-founded helped end that in 2004 by writing a complaint together with a brave but lonely member of Congress who was willing to file it with the House Ethics Committee. The resulting investigation resulted in the discipline of the member investigated, and ultimately helped lead to his party losing majority control of the body.

Out of all of that came a new enforcement tool in 2008, in our House of Representatives, that I strongly recommend to you: the creation of a new, independent entity, the Office of Congressional Ethics (OCE). This is a nonpartisan fact-finding body that investigates allegations from any source, including whistleblowers who might otherwise be afraid to step forward. OCE then recommends action to the parliamentarians who constitutionally maintain the ultimate decision-making power. Most importantly, the OCE referrals become public, allowing press, civil society and voter accountability. As a result, I believe, since the creation of the OCE for our House in 2008, there have been a significantly higher number of meritorious investigations there than in our Senate, which does not have a comparable body. The total is about 46 OCE referrals and about 20 House disciplinary actions versus just four letters of admonition by our Senate in that period. To be fair the Senate is a smaller body—but not that much smaller!

That last aspect of OCE enforcement—transparency, and the accountability it brings from media, NGOs and the public—is the sixth and final point I want to emphasize. In our U.S. parliamentary ethics system we have many transparency mechanisms: asset disclosures that our parliamentarians file, disclosures that lobbyists must make about their activities, information in campaign finance filings, and more.

To explain the value of transparency, I would like to close by turning to one of our Obama White House ethics transparency innovations. Starting in 2009, we for the first time put on the Internet virtually all visitor records of those coming to the White House. It used to be that just to get a handful of these records you had to file litigation and wait for years to know who was coming to the White House, who they were meeting with and what the subject of the meeting was. Now millions of Obama White House visitor records are online, each with a dozen or so basic categories of information: the name of the visitor, the person visited, the subject of the meeting and so on.

Why is that important? I began by referencing the Obama White House's record in avoiding major scandal. I think there are a number of reasons for that, including the President's own integrity and the new code of conduct we put into place. But an important part of that success story has also been the fact that records of White House meetings go on the Internet for everyone to see. That transparency brings accountability from the press, civil society and the public. That transparency and accountability has in turn powerfully reinforced the code of conduct: it has discouraged people from having meetings they shouldn't have, and if you don't have the meeting, you can't get in trouble for it.

So the U.S. view in one sentence: regulate conflicts, gifts, employment, and resource use, with strong enforcement and above all transparency. Thanks again for inviting me to share the U.S. perspective. Grazie!

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Three keys to reforming government: Lessons from repairing the VA


On June 20, I moderated a conversation on the future of the Department of Veterans Affairs with Secretary Robert McDonald. When he took office almost two years ago, Secretary McDonald inherited an organization in crisis: too many veterans faced shockingly long wait-times before they received care, VA officials had allegedly falsified records, and other allegations of mismanagement abounded.

Photo: Paul Morigi

Since he was sworn into office, Secretary McDonald has led the VA through a period of ambitious reform, anchored by the MyVA program. He and his team have embraced three core strategies that are securing meaningful change. They are important insights for all government leaders, and private sector ones as well.

1. Set bold goals

Secretary McDonald’s vision is for the VA to become the number one customer-service agency in the federal government. But he and his team know that words alone won’t make this happen. They developed twelve breakthrough priorities for 2016 that will directly improve service to veterans. These actionable short-term objectives support the VA’s longer term aim to deliver an exceptional experience for our veterans. By aiming high, and also drafting a concrete roadmap, the VA has put itself on a path to success.

2. Hybridize the best of public and private sectors

To accomplish their ambitious goal, VA leadership is applying the best practices of customer-service businesses around the nation. The Secretary and his colleagues are leveraging the goodwill, resources, and expertise of both the private and public sector. To do that, the VA has brought together diverse groups of business leaders, medical professionals, government executives, and veteran advocates under their umbrella MyVA Advisory Committee. Following the examples set by private sector leaders in service provision and innovation, the VA is developing user-friendly mobile apps for veterans, modernizing its website, and seeking to make hiring practices faster, more competitive, and more efficient. And so that no good idea is left unheard, the VA has created a "shark tank” to capture and enact suggestions and recommendations for improvement from the folks who best understand daily VA operations—VA employees themselves.

3. Data, data, data

The benefits of data-driven decision making in government are well known. As led by Secretary McDonald, the VA has continued to embrace the use of data to inform its policies and improve its performance. Already a leader in the collection and publication of data, the VA has recently taken even greater strides in sharing information between its healthcare delivery agencies. In addition to collecting administrative and health-outcomes information, the VA is gathering data from veterans about what they think . Automated kiosks allow veterans to check in for appointments, and to record their level of satisfaction with the services provided.

The results that the Secretary and his team have achieved speak for themselves:

  • 5 million more appointments completed last fiscal year over the previous fiscal year
  • 7 million additional hours of care for veterans in the last two years (based on an increase in the clinical workload of 11 percent over the last two years)
  • 97 percent of appointments completed within 30 days of the veteran’s preferred date; 86 percent within 7 days; 22 percent the same day
  • Average wait times of 5 days for primary care, 6 days for specialty care, and 2 days for mental health are
  • 90 percent of veterans say they are satisfied or completely satisfied with when they got their appointment (less than 3 percent said they were dissatisfied or completely dissatisfied).
  • The backlog for disability claims—once over 600,000 claims that were more than 125 days old—is down almost 90 percent.

Thanks to Secretary McDonald’s continued commitment to modernization, the VA has made significant progress. Problems, of course, remain at the VA and the Secretary has more work to do to ensure America honors the debt it owes its veterans, but the past two years of reform have moved the Department in the right direction. His strategies are instructive for managers of change everywhere.

Fred Dews and Andrew Kenealy contributed to this post.

Authors

Image Source: © Jim Bourg / Reuters
       




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Government spending: yes, it really can cut the U.S. deficit


Hypocrisy is not scarce in the world of politics. But the current House and Senate budget resolutions set new lows. Each proposes to cut about $5 trillion from government spending over the next decade in pursuit of a balanced budget. Whatever one may think of putting the goal of reducing spending when the ratio of the debt-to-GDP is projected to be stable above investing in the nation’s future, you would think that deficit-reduction hawks wouldn’t cut spending that has been proven to lower the deficit.

Yes, there are expenditures that actually lower the deficit, typically by many dollars for each dollar spent. In this category are outlays on ‘program integrity’ to find and punish fraud, tax evasion, and plain old bureaucratic mistakes. You might suppose that those outlays would be spared. Guess again. Consider the following:

Medicare. Roughly 10% of Medicare’s $600 billion budget goes for what officials delicately call ‘improper payments, according to the 2014 financial report of the Department of Health and Human Services. Some are improper merely because providers ‘up-code’ legitimate services to boost their incomes. Some payments go for services that serve no valid purpose. And some go for phantom services that were never provided. Whatever the cause, approximately $60 billion of improper payments is not ‘chump change.’

Medicare tries to root out these improper payments, but it lacks sufficient staff to do the job. What it does spend on ‘program integrity’ yields an estimated $14.40? for each dollar spent, about $10 billion a year in total. That number counts only directly measurable savings, such as recoveries and claim denials. A full reckoning of savings would add in the hard-to-measure ‘policeman on the beat’ effect that discourages violations by would-be cheats.

Fat targets remain. A recent report from the Institute of Medicine presented findings that veritably scream ‘fraud.’ Per person spending on durable medical equipment and home health care is ten times higher in Miami-Dade County, Florida than the national average. Such equipment and home health accounts for nearly three-quarters of the geographical variation in per person Medicare spending. Yet, only 4% of current recoveries of improper payments come from audits of these two items and little from the highest spending locations.

Why doesn’t Medicare spend more and go after the remaining overpayments, you may wonder? The simple answer is that Congress gives Medicare too little money for administration. Direct overhead expenses of Medicare amount to only about 1.5% of program outlays—6% if one includes the internal administrative costs of private health plans that serve Medicare enrollees. Medicare doesn’t need to spend as much on administration as the average of 19% spent by private insurers, because for example, Medicare need not pay dividends to private shareholders or advertise.

But spending more on Medicare administration would both pay for itself—$2 for each added dollar spent, according to the conservative estimate in the President’s most recent budget—and improve the quality of care. With more staff, Medicare could stop more improper payments and reduce the use of approved therapies in unapproved ways that do no good and may cause harm.

Taxes. Compare two numbers: $540 billion and $468 billion. The first number is the amount of taxes owed but not paid. The second number is the projected federal budget deficit for 2015, according to the Congressional Budget Office.

Collecting all taxes legally owed but not paid is an impossibility. It just isn’t worth going after every violation. But current enforcement falls far short of practical limits. Expenditures on enforcement directly yields $4 to $6 for each dollar spent on enforcement. Indirect savings are many times larger—the cop-on-the-beat effect again. So, in an era of ostentatious concern about budget deficits, you would expect fiscal fretting in Congress to lead to increased efforts to collect what the law says people owe in taxes.

Wrong again. Between 2010 and 2014, the IRS budget was cut in real terms by 20%. At the same time, the agency had to shoulder new tasks under health reform, as well as process an avalanche of applications for tax exemptions unleashed by the 2010 Supreme Court decision in the Citizens United case. With less money to spend and more to do, enforcement staff dropped by 15% and inflation adjusted collections dropped 13%.

One should acknowledge that enforcement will not do away with most avoidance and evasion. Needlessly complex tax laws are the root cause of most tax underpayment. Tax reform would do even more than improved administration to increase the ratio of taxes paid to taxes due. But until that glorious day when Congress finds the wit and will to make the tax system simpler and fairer, it would behoove a nation trying to make ends meet to spend $2 billion to $3 billion more each year to directly collect $10 billion to 15 billion a year more of legally owed taxes and, almost certainly, raise far more than that by frightening borderline scoff-laws.

Disability Insurance. Thirteen million people with disabling conditions who are judged incapable of engaging in substantial gainful activity received $161 billion in disability insurance in 2013. If the disabling conditions improve enough so that beneficiaries can return to work, benefits are supposed to be stopped. Such improvement is rare. But when administrators believe that there is some chance, the law requires them to check. They may ask beneficiaries to fill out a questionnaire or, in some cases, undergo a new medical exam at government expense. Each dollar spent in these ways generated an estimated $16 in savings in 2013.

Still, the Social Security Administration is so understaffed that SSA has a backlog of 1.3 million disability reviews. Current estimates indicate that spending a little over $1 billion a year more on such reviews over the next decade would save $43 billion. Rather than giving Social Security the staff and spending authority to work down this backlog and realize those savings, Congress has been cutting the agency’s administrative budget and sequestration threatens further cuts.

Claiming that better administration will balance the budget would be wrong. But it would help. And it would stop some people from shirking their legal responsibilities and lighten the burdens of those who shoulder theirs. The failure of Congress to provide enough staff to run programs costing hundreds of billions of dollars a year as efficiently and honestly as possible is about as good a definition of criminal negligence as one can find.

Authors

     
 
 




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