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Can the U.S. still tackle big problems? Lessons from the health-care battle.

By William D. Eggers and John O'Leary
Sunday, March 21, 2010; B01

At the height of the debate over health care last month, Vice President Biden put into simple terms a feeling that has become pervasive across America. "Washington, right now, is broken," he said.

This from a nation that won World War II, split the atom and, yes, even put a few guys on the moon. For years, Washington has been shooting at some big targets -- fighting the wars in Iraq and Afghanistan, dealing with the aftermath of Hurricane Katrina, reforming immigration policy -- and too often missing the mark. And the arduous health-care reform effort, with its year-long debate, recriminations and dividing lines, only seems to prove how fraught and complex it has become for America to tackle ambitious tasks.

Some blame the red team, others blame the blue team. But most blame "the system," as though our 234-year-old experiment with representative democracy has failed in a fit of partisanship and dashed expectations. "Our government is old and broken and dysfunctional, and may even be beyond repair," wrote the Atlantic's James Fallows, in a typical lament. And in a radio address last fall, even President Obama felt compelled to reassure us that "we can still do big things in America."

The problem is not our system. By design, democracy is slow to change course; new ideas always face a lengthy struggle. Rather, the problem is that the ways in which we have come to use this system -- how we develop ideas, test them and put them into action -- need repair.

We've studied more than 75 major U.S. government initiatives since World War II, looking for patterns and lessons, and in so doing have explored great successes and monumental failures. We wanted to understand how the same country that launched the Manhattan Project could imagine that "Whip Inflation Now" buttons would curb rising prices, why the nation that rescued war-torn Europe could fail to rescue New Orleans and the Gulf Coast.

Although there are lots of ways that even well-intentioned projects can go awry, we found that successful initiatives tend to get some key elements right. We offer five simple principles that, if followed, could help renew America's ability to accomplish big things.

Capitalize on disagreement.

Bad ideas generally become reality when they aren't exposed to external criticism, when they emerge from the echo chamber of a small group of like-minded advocates. (Think of the introduction of "new math" teaching methods or the run-up to the latest Iraq war.) Significant successes, on the other hand, generally occur when leaders cross boundaries of ideology and expertise to exchange ideas with those who see the world differently.

For example, President Bill Clinton worked with a Republican Congress to enact welfare reform in 1996 -- resulting in plummeting caseloads. In Massachusetts, Mitt Romney and a Democratic legislature used market-based initiatives to expand health coverage to 97 percent of the state's population -- and provided national reformers with a preview of the benefits and drawbacks of their approach.

Openness to different perspectives creates a mash-up of ideas from unrelated fields and can produce new solutions to old problems. In the 1980s, for example, the battle over how to deal with acid rain was stuck in a logjam between corporate interests and environmentalists. Sens. Jack Heinz and Tim Wirth, a Republican and a Democrat, worked together on an emission-trading scheme based on "free market environmentalism." The result: a cap-and-trade approach that was one of the most successful environmental programs of all time, cutting sulfur dioxide emissions by 40 percent in the United States without crippling business. The key is to break free of bias by inviting new voices into the idea-generation process early on.

Design for the real world -- not just for Congress.

As the health-care battle has shown, the imperatives of the legislative process often seem to trump all else, resulting in bills that can pass Congress but that might not work in practice. The No Child Left Behind Act of 2001, the immigration reform of 1986 and the Freedom to Farm Act of 1996 all suffered from this trap, which we call "design-free design." All passed with healthy bipartisan majorities, and all had results so disappointing that politicians soon found themselves going back to the drawing board.

Avoiding this problem begins by realizing that it's far better to replicate an approach that has already proved itself in the real world than to launch an entirely novel solution. For example, welfare reform succeeded in part because Congress had the luxury of learning from innovative approaches in Wisconsin, Oregon and elsewhere. "We had a lot of evidence about what would work," explained Ron Haskins, who was the senior congressional staffer who wrote the legislation. "Many states had demonstration programs before we wrote the bill. We just rode the wave."

This principle also worked during the current Iraq war: The Pentagon and the Bush administration could have greater confidence in the troop surge of 2007 because it replicated a strategy that had proved itself in Anbar province.

Embrace the public debate.

The Marshall Plan is considered one of the greatest achievements in 20th-century U.S. foreign policy, but when the idea was first raised, most Americans and most members of Congress weren't enthused. Americans were worried about their own economy after World War II. Isolationist forces were powerful. And the Republican majority on Capitol Hill was elected on a platform of limited government, anti-interventionism and fiscal conservatism.

Yet eventually the Marshall Plan passed by a large margin in Congress and enjoyed strong public support. How did President Harry Truman, Gen. George Marshall and company make it happen?

First, they educated Americans about the benefits of the plan, launching what may have been the largest peacetime information campaign in history. Marshall, Commerce Secretary Averell Harriman, Secretary of State Dean Acheson and other supporters barnstormed the country. A citizens committee organized a massive, well-funded PR effort that included millions of pieces of pro-Marshall Plan literature, from booklets to opinion essays in newspapers across the country.

The committee was smart about several things. First, it was bipartisan, with the leadership divided equally between Republicans and Democrats. Second, it eschewed ideological arguments for a more even-handed approach. "We should not embark on a Marshall Plan program," cautioned committee member and future CIA chief Allen Dulles, "until we have counted the effort, the cost and the sacrifice that we are disposed to put into it."

Third, the committee worked to persuade Americans to commit to the key goals of the Marshall Plan -- Europe's economic recovery and social stability, and the development of private industry and free trade -- before starting to talk about specific dollar figures.

Supporters also played it smart in Congress. Rather than steamroll the bill through, they encouraged discussion and hearings. They even arranged tours of battle-ravaged Europe for members of Congress; these moving visits helped more than any abstract arguments to convert skeptical lawmakers into supporters of the plan.

Not all such education efforts will resonate -- remember President George W. Bush's push to convince the public of the need for Social Security reform, and the contentious town hall gatherings on health care last fall? -- but the absence of real discussion can raise public suspicions that politicians have something to hide.

Take failure seriously.

In public life, everything is harder than it seems. You would think that a string of disappointments might dampen our confident political rhetoric, but it hasn't. Even with public approval of our political leaders quite low, they brim with conviction that their plans will cut costs, fix problems and come in on time and under budget. Such overconfidence is very much a bipartisan phenomenon, and it only makes the job harder. Considering only the best-case scenario produces unrealistic budgets and impossible timelines.

Iraq offers a classic example. Rebuilding the country was supposed to be easy, and as a result, the Bush administration gave scant attention to what might happen after the "shock and awe" subsided. Enforced optimism meant there was no Plan B.

Politicians and bureaucrats must learn to talk to each other.

What do the Apollo mission, the 1964 Alaska earthquake recovery and the Iraq troop surge all have in common? Critical to the success of each was the presence of a "bridger." This is a leader who can move between the political and bureaucratic worlds -- the rare person who can translate bureaucratic language to politicians and tell the political masters when they are off course.

With Apollo it was NASA Administrator James Webb; in Alaska it was career civil servant Dwight Ink; with the surge it was Gen. David Petraeus. Such individuals are critical to executing history-making undertakings but are often undervalued at the time.

Webb was a quintessential bridger. President John F. Kennedy chose him to lead NASA through the political, administrative and technical challenges of putting a man on the moon, and it proved a wise decision. Though an early draft of Kennedy's 1961 man-on-the-moon speech had set 1967 as the goal for a lunar landing, Webb added what he called an "administrative discount" of two years to account for unforeseen contingencies. He also doubled the cost estimates developed by NASA for the Apollo mission before sending them to the president, adding his administrative realism to counter the optimism of his technical staff.

Webb's prudence helped NASA avoid the overconfidence trap and helped ensure that critical resources would be available when needed. After all, nobody wants to go halfway to the moon. Webb's conservative estimates turned out to be just about right.

Today, the costs of major public initiatives are routinely low-balled. Boston's Big Dig highway megaproject was at first projected to cost $2.6 billion. By the time it was completed in the winter of 2007-2008, its price tag was an astounding $22 billion. (No wonder the public is so skeptical of the cost estimates for health-care reform.)

Fifty years ago, Kennedy challenged our nation to put a man on the moon within a decade. We were inspired to success in part because we believed we could do it; we were in the habit of accomplishing great and difficult tasks. By contrast, in 2004, Bush announced that we were heading back to the moon by 2020. We were skeptical, and when NASA recently announced that it was abandoning the moon mission, no one was terribly surprised. We have grown accustomed to falling short of our goals.

We don't need to look to outer space to find challenges worth tackling. There are plenty of problems right here at home that need attention. But are we up to the task?

It's easy to look at Washington today and conclude that our political class is too partisan and polarized for anything to work, that the spirit of cooperation that allowed us to win World War II and defeat communism is a relic of a distant age and a long-abandoned culture. Such cynicism is easy, whereas fixing the problem is hard. But it is not too late to recognize that once again democracy is on trial and that our dysfunctional governing process is every bit as menacing to our future as external enemies. Surely the stakes are high enough: If we fail to fix the process by which we achieve our great ambitions, what chance do we have of solving the challenges of today and tomorrow?

john@joleary.com

weggers@deloitte.com

William D. Eggers is the global research director in the public sector practice of Deloitte, an accounting and advisory firm. John O'Leary is a research fellow at the Ash Center at Harvard's Kennedy School of Government. They are the authors of "If We Can Put a Man on the Moon: Getting Big Things Done in Government."

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