Monday, April 30, 2012

A Healthy Society - Chapter 2 Discussion

Chapter 2 of Ryan Meili's A Healthy Society discusses the place of politics as "medicine on a larger scale". Meili looks for lessons in our political discussion based on how medical knowledge has advanced in the past few decades, and points out a new definition of success that looks to be entirely transferable to our expectations of government:
One interesting result of this approach is that the definition of success has changed. We now talk about meaningful outcomes. When we know what is meaningful to patients and their families, we can know whether to move ahead with a difficult treatment, or spare the expense and discomfort. The guiding principle is to do what will make the most meaningful improvement in the patient’s quality of life rather than a focus on cure rates, survival times, or adherence to strict guidelines. This humanizing approach, based on what is significant in improving people’s lives rather than an insensitive numerical standard, is an important principle to remember when we discuss political interventions as well as medical.
Of course, this doesn't figure to mean that measurable standards are entirely inapplicable, as Meili notes in discussing the move toward evidence-based medicine as another advance which we should seek to import into political discussion:
The analogy of the past practice of medicine and the current practice of politics is striking. Rather than on the best evidence, political decisions are made based on a polling of their popularity, ideology, and other sorts of best guesses of what might work. What is needed is a move to evidence-based policy. We need to develop the clearest understanding possible of our goals, our meaningful outcomes. We then must understand the obstacles to reaching them, and the actions most likely to have the desired effect. We need to use the best information and examples available to us in order to build a healthy society.
But it's worth keeping in mind the lesson that it's impossible to arrive at the right answer as to how to make government work for people without constant engagement to determine whether we're asking the right questions. And the difference in incentives between the private and public sectors may offer a hint as to the role government can and should play.

After all, businesses figure to be motivated to take an individual's concerns into account only to the extent it's profitable to do so. But government actors bear responsibility for all people within their jurisdiction - and are ultimately responsible to make sure that everybody is included in decision-making.

Rather than applying the choose-from-a-predetermined-menu service model to the public sector, we should thus consider how we can set up our civil service to be able to achieve meaningful results in as many cases as possible, rather than being overly confined by top-down program definitions which leave too many concerns being answered with "that's not my job" or "we can't do that". And that flexibility in turn should be subject to a careful evaluation as to whether intervention on that basis achieves value for the resources used - which can both highlight areas of citizen demand that aren't being addressed, and determine which options might need to be closed off.

[Edit: fixed typo.]

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