Reinventing Government, Reinventing Health

ON SEPTEMBER 7 Vice President Al Gore presented the Report of the National Performance Review, promising to reduce both the budget deficit and the “trust deficit” by reinventing government. The theme is that government officials and civil servants should be treated like responsible adults. The government should rely more on incentives and less on controls, increasing flexibility in exchange for increased accountability. The regulation of federal managers and the level of unfunded mandates on state and local governments should be massively reduced. No longer would agencies be required to purchase supplies and support services through monopoly purchasing agencies. Bureaucracy, paperwork, and waste would be reduced by increased competition, both from private suppliers and from other agencies. (David Osborne, the author of Reinventing Government, apparently read my 1971 book, Bureaucracy and Representative Government.) Government would operate more like a business.

On September 22, President Clinton summarized his complex plan to reform American health care, a major reorganization of this huge sector of the economy, the most expansive domestic-policy proposal since the New Deal. As is often the case, he was very articulate in describing the benefits of his proposed plan. The theme of this plan is very different from that of the Gore report. Patients and physicians are to be treated not as responsible adults but as pawns in a massive experiment in social engineering. The plan would rely more on controls and less on incentives, reducing the range of choice now in exchange for a promise of lower costs in the future. The regulation of health-care providers and the mandates on all employers would be massively increased. No longer would employers and individuals be allowed to select the health-insurance coverage they prefer; instead they would be required to buy a government-defined standard benefit package through a government-appointed monopoly purchasing agent in each region. Bureaucracy, paperwork, and waste would be increased by reduced competition, both among insurance companies and among health-care providers. The market for health care would be transformed into one giant government-managed bureaucracy.

WN

About the Author

William Niskanen

Featured Tags

ON SEPTEMBER 7 Vice President Al Gore presented the Report of the National Performance Review, promising to reduce both the budget deficit and the “trust deficit” by reinventing government. The theme is that government officials and civil servants should be treated like responsible adults. The government should rely more on incentives and less on controls, increasing flexibility in exchange for increased accountability. The regulation of federal managers and the level of unfunded mandates on state and local governments should be massively reduced. No longer would agencies be required to purchase supplies and support services through monopoly purchasing agencies. Bureaucracy, paperwork, and waste would be reduced by increased competition, both from private suppliers and from other agencies. (David Osborne, the author of Reinventing Government, apparently read my 1971 book, Bureaucracy and Representative Government.) Government would operate more like a business.

On September 22, President Clinton summarized his complex plan to reform American health care, a major reorganization of this huge sector of the economy, the most expansive domestic-policy proposal since the New Deal. As is often the case, he was very articulate in describing the benefits of his proposed plan. The theme of this plan is very different from that of the Gore report. Patients and physicians are to be treated not as responsible adults but as pawns in a massive experiment in social engineering. The plan would rely more on controls and less on incentives, reducing the range of choice now in exchange for a promise of lower costs in the future. The regulation of health-care providers and the mandates on all employers would be massively increased. No longer would employers and individuals be allowed to select the health-insurance coverage they prefer; instead they would be required to buy a government-defined standard benefit package through a government-appointed monopoly purchasing agent in each region. Bureaucracy, paperwork, and waste would be increased by reduced competition, both among insurance companies and among health-care providers. The market for health care would be transformed into one giant government-managed bureaucracy.