Creating A Dramatically Better, More Prosperous, Healthier And Safer America:
The Case For TRANSFORMATIONAL Government, Politics And News Media Coverage
President George W. Bush and Secretary of Defense Don Rumsfeld have the correct approach in insisting on a review of the opportunities and requirements of national security rather than simply asking for more money for the traditional system. Furthermore their insistence on a transformation in national security is exactly right as a principle. This approach should be extended to every area of government.
As a participant in the Hart-Rudman Commission on National Security to 2025 I had the opportunity to meet with a number of key scientists and visit a number of laboratories and universities. For the last three years I have been visiting with entrepreneurs and managers who are using human and financial resources to create new knowledge and deliver new goods and services.
It is clear that we are on the edge of an extraordinary revolution in scientific knowledge that will in the next 25 years probably increase our understanding of the natural world by more than all the breakthroughs of the 20th century combined (see proposition three below). In this period of accelerating scientific and technological change the gap between current government practice and current private sector practice is continually widening. I concluded that traditional, managerial efforts at improving the current government approaches at the state, federal, and local level would simply fall further and further behind the opportunities. If allowed to continue, this gap will cost lives and dollars as government fails
to take advantage of the new solutions that are available but are invisible to the political world. We need an approach that focuses on a TRANSFORMATIONAL vision and set of strategies. In a sense we need the focus to be on the improvement and change that was created by Theodore Roosevelt and the Progressive Movement a century ago as they sought to bring the capabilities of modern industrial corporations into modernizing government. This vision of a more powerful, more prosperous future through a new transformational approach can be explained in a series of eight propositions.
Proposition 1: We are on the verge of creating an extraordinary explosion of new solutions that will dramatically improve our lives, our communities and the delivery of societal and governmental goods and services.
These new breakthroughs in science, technology, entrepreneurship, and managerial capabilities will lead to enormous increases in productivity and in solving problems over the next two to three decades.
Eliminating Alzheimer's is a plausible goal for the next quarter century and its achievement would dwarf anything that could possibly be achieved by regulating or micromanaging the pharmacy industry. Creating a model information based nursing home and then finding a way to capitalize its replication throughout the country would improve the lives of hundreds of thousands of senior citizens far more than any new battery of paperwork and hostile inspections conducted by the current state and federal bureaucracies. The application of existing private sector and laboratory capabilities to the public sector would improve the lives of people and the productivity of government by orders of magnitude.
The potential that will be created in the next quarter century will be immense. This requires a real focus by politicians, government officials, and the political-governmental branches of the news media on these capabilities. The best of the business community, the scientific and technological aspects of the academic community, many of the business and science media and the laboratory oriented parts of the government already know that there is vastly more potential to improve lives and improve public policy than the political and bureaucratic components of the public sector understand or are drawing on. This requires a real focus by politicians, government officials, and the political-governmental branches of the news
media on these capabilities. This will only happen if there is a real focus on transformational rather than managerial politics and government. If we focus on managing the current government and debating the current government we will never have the time and energy to focus on developing the transformation to a far more productive future.
Proposition 2: Creating this better future will do far more to improve peoples' lives than will marginal, micromanaged improvements in the current failed bureaucracies.
In area after area we need to focus on strategies of replacement rather than strategies of repair. It is not possible to repair the Health Care Financing Administration model with its 135,000 plus pages of micro-regulation (more than three times the number of pages of IRS regulations). A more efficient micro-regulation approach would actually be a bigger failure with worse outcomes for health care.
This requires a real focus by politicians, government officials, and the political-governmental branches of the news media on this capabilities failure. It is not possible to use traditional systems to retro-educate all the people who have failed to learn reading, math and science in the last generation and yet we need their skills and abilities. There has to be a new adult education opportunity for every person who wants to learn at whatever age they wake up and realize their current skills are inadequate. To fit the realities of busy information age lives, this new system has to be built around 24/7 accesses from home, work or vacation. This requires a high tech information age approach that is totally different
from the creation of more traditional classes in adult education desinged to reach 1 or 2 per cent of the potential market.
An epidemic in diabetes requires bold new policies implemented in effective new ways (the HCFA approach to the Congressional funding of a massive increase in diabetes education has actually shrunk the number of institutions currently providing that education and has lowered the number of recipients).
In a world where bank customers use 24/7 free standing automatic teller machines and drivers fill their own cars with self service gas pumps that take credit cards there are clearly dramatic new opportunities to provide information and services beyond the regulatory and bureaucratic patterns that grew up in the pre-computer, pre-internet, pre-wireless world.
Focusing on these new systems and new solutions will save more lives, improve more futures, create greater wealth, save more biodiversity, enhance the environment more, and provide more public safety and national defense than any possible combination of the current litigation-regulation-bureaucratic models we have relied on.
Proposition 3: We can value in human lives, in human quality of life, in key values, and in money, the cost of slowing these changes down.
Every month that inappropriate regulations, adversarial government systems, litigious interpretations of entrepreneurial efforts keep the new knowledge from helping people, lives are lost and the quality of life is lessened.
The Institute of Medicine estimates that 44,000 to 98,000 Americans a year die in hospitals from medical errors. This does not include nursing homes or outpatient care. It also does not include "hospital induced illness" which may be more than twice the size of the medical error problem.
An aggressive application of a modern systems approach to medical information using electronic prescriptions, handheld and laptop devices for doctors and nurses, electronic medical records, expert systems for analysis, and routine systematic 24/7 organizational approaches would probably save 25,000 lives annually at a minimum. Nothing the current bureaucratized system can do will have that effect. Every year we fail to modernize medicine we decide to allow at least 25,000 more Americans to die unnecessarily.
The issue of transformation can be carried over to literacy achieved in education, species saved in the right kind of biodiversity program, reductions in pollution, savings in tax dollars and a host of other variables. Again and again the result will be the same. Applying the new technologies and new science will provide better services at lower cost. In many cases applying the new technologies and new science will produce results that are literally unachievable by any current government activity.
If you were the mother who lost her nine month old baby in a Washington-area hospital because there was no modern system for prescribing and administering morphine you would be enraged to know that the public sector has known about the problem for years and simply refused to change. That is the human face of failing to transform.
Proposition 4: This opportunity to dramatically improve our lives, our communities and our country is driven by two very different waves of change. The first is built around the computer revolution and the Internet and already exists. The second is just beginning to emerge and is a combination of nano-scale (nano refers to one-billionth, nano-scale is about one atom to four hundred atoms in size) science and technology, quantum behavior, and biology.
First, we need to bring government into the 21st century by implementing all the opportunities that surround us in everyday use. The most modern and aggressive institutions in our society (among them large structures like General Electric, Microsoft, Wal-Mart and thousands of very small institutions) have systems of excellence, habits of adaptation, understanding of how to use information technology, and approaches to team building and management that are in many ways antithetical to our current government structures and patterns.
In some areas the gap is now so large that many of our most entrepreneurial and technologically advanced companies refuse to bid on government contracts because they do not want their management to become confused, slowed down, and misdirected by learning how to work with bureaucracies that are designed in counterproductive and often destructive patterns.
Our first step must be to assess WHAT IS ALREADY WORKING and simply BRING THE GOVERNMENT INTO THE 21ST CENTURY. This is actually a simple process of looking at what works in your everyday life and then trying to figure out where it applies in government and what has to change for government to be as timely and as effective as the rest of society. The second stage will require a bigger leap of imagination because it suggests that we have to acquire some notion of the scale of opportunity created by the emerging revolution in science. The breakthroughs in nano-scale science and technology, quantum behavior, and biology will create many new and better ways of doing things. Millions of lives will be saved and virtually
every life will be improved if the public sector can grasp and adapt to the opportunities science will be unfolding on an almost daily basis. The early stages of this revolution have been occurring over the last decade or more but they are accelerating and will become a vast river of change in the next few years.
A quantum computer would be a million times more powerful than any current computer and would change totally the question of encryption. A nano-scale breakthrough could make desalinization totally affordable and solve major water shortages in much of the world. Nano-scale devices could become instant warning devices for cancer sitting inside our bodies at a level we would not notice and reporting the first time there is a single cancer cell (and conceivably destroying the cell in the process and eliminating the cancer without radiation or chemotherapy).
These are not the opportunities of fantasy or science fiction. They are small examples of work currently underway in laboratories. Ironically government research funded the education of most of these pioneers, paid for and is paying for most of the basic research but government itself is clearly lagging in its use of almost all of the breakthroughs it has helped create.
Proposition 5: We have seen waves of change driven by science and technology for the last three hundred years and there is a consistent and learnable pattern to their impact on society and their adoption of enlightened political and governmental leaders.
Adam Smith was studying the rise of the commercial world and early industrial manufacturing. The Wealth of Nations was a book of reporting which codified observable daily realities. Smith was not a theoretician. He was a student of a world that was emerging around him. His disciples, the Smithites, profoundly shaped the government of William Pitt the Younger in the 1780s and 1790s and their reforms laid the basis for the financial strength and manufacturing strength that allowed Britain to defeat Napoleon. In America, Alexander Hamilton, was a follower of Smith, and applied the same modernizing economics as the first Secretary of the Treasury. His First Report on Manufactures and Report on the National Debt remain
models of applying Smithite principles to public policy.
By the 1840s the wave of industrial development led to the rise of the English Liberals. They were dedicated to concept of a smaller government with fewer regulations and less bureaucracy to minimize the impediments to modernizing industry and new inventions. The greatest improvement in public health came about as the new process of manufacturing led to the creation of water pipes and sewer pipes thus revolutionizing public sanitation. Modernizers like Richard Cobden, John Stuart Mill, and Walter Bagehot's founding of the Economist magazine were deliberate efforts to bring the new concepts of industrial productivity into politics and government. The Economist to this day remains the most consistent journalistic effort
to stand above managerial politics of daily events and focus on the longer-term principles of a successful entrepreneurial world of technological and scientific change.
The application of the steam engine to transportation by Robert Fulton on boats and George Stephenson on rails dramatically changed life and improved the standard of the living for the average citizen far more than any nineteenth century government bureaucracy. Stephen Ambrose's Nothing Like It in the World makes vivid how deeply political building the transcontinental railroads was and how much it combined visionary leadership, advancing technology, sectional interests, private entrepreneurs, a multiethnic immigrant workforce and government subsidies. It is a useful parable for our own era.
Theodore Roosevelt and the Progressives sought to bring the tools of modern national corporations to bear on the challenges of the public sector. They were rationalizers in the same way that Andrew Carnegie and John D. Rockefeller had been rationalizers in business a generation earlier. Indeed the great difference between the Populists and the Progressives was the unwillingness of the former to accept or adapt to the emerging world and the willingness of the latter to adapt from the emerging industrial corporate world systems and habits that could improve government.
There are many lessons that can be learned from these periods of dramatic change in science and technology, the application of those changes by the private sector and the gradual adoption of those changes by government. In countries that had leaders who were knowledgeable of and comfortable with those changes the nation prospered and people's lives improved dramatically. In countries where the political elites rejected the emerging capabilities the bureaucracies failed to change and the public was impoverished by comparison. Ultimately the power of the changes was so enormous that in every case they eventually were accepted (no place today rejects steam engines for example or railroads or even the more modern internal
combustion engine). However to have a political, governmental, and news media elite that takes the changes seriously, studies them and seeks to modify public policy to make use of them creates an enormous difference in how long it takes to bring the new ideas and new knowledge to bear in saving peoples lives and in improving those lives on a daily basis.
Proposition 6: Accelerating the transformation requires public leaders, governmental leaders, politicians, and the political news media to learn about the two waves of science and technology, which make them possible. In earlier eras it was necessary for transformational leaders to understand the implication of the steam engine, the steamboat, the railroad, the automobile, etc. Now it is important for leaders to understand the power of the information age and the internet which provides the first wave of change and also to understand the combination of nano-scale science and technology, quantum behavior, and biology which will drive the second great wave of change.
This does not require modern leaders and reporters to become scientists. However it is no accident that Theodore Roosevelt was the first American President to ride in a car, that Winston Churchill learned how to fly in 1913 only ten years after the first manned flight by the Wright brothers, or that Lincoln had been a visionary advocate of the railroad and a railroad lawyer before signing the transcontinental railroad bill as President.
The earlier more mature wave of change based on the information revolution, the computer and the Internet is also the more accessible. Many companies have done a great job of using these tools and concepts government could be dramatically changed by simply catching up with current developments in the private sector. Many political and governmental reporters and editorial writers could also learn by talking with their colleagues who cover business and science.
Virtually every government bureaucracy should have an outside advisory commission of successful entrepreneurs, managers and scientists charged with helping develop strategies of transformation for their sector.
In the second wave of change more imagination needs to be adopted and more foresight used. Even in this area there are hundreds of scientists who can give compelling pictures of the changes that are coming. Craig Venter's revolution in the development of research offers the potential for such a flood of biological information that every person concerned about medical breakthroughs should be studying it and seeking to apply it to other institutions. Richard Klaustner's vision of a global informatics for cancer is a taste of the world to come. Mike Roco's understanding of emerging patterns in nano-scale research will spark the imagination of anyone willing to listen. The knowledge is emerging but the gap between that
knowledge and public policy activists is simply too big to be gapped today.
One of our primary challenges is to build bridges and intersections between those who know and those who decide.
Proposition 7: Creating a transformation requires asking new questions and creating new systems, attitudes and habits. In the current micro-managed, adversarial, bureaucratic system we ask the wrong questions, focus on the wrong problems, and punish the wrong people. The result is a Washington process that inhibits the development of the future in the news stories its media covers, the hearings its congress holds, and the forms its bureaucracies want filled out. It is mind numbing and maddening.
Let's start by asking bold new questions. Over the next quarter century could we: eliminate Alzheimer's disease? Turn most cancers into avoidable, minimizable, or manageable events? Create a system for both the individual and for society that would make diabetes either curable or controllable with virtually no unhealthy consequences? Minimize the carbon dioxide load (global warming) without lowering our standard of living? Create a system of managing biodiversity across the planet? Create a permanent 24/7 access to learning, from basic literacy through advanced degrees, so every American could learn all their lives? Use high tech to relieve doctors, nurses and teachers so they could focus less of their time on paper
and record keeping and more of their time on patients? Reduce the size and cost of government while increasing its effectiveness, something virtually every major corporation does routinely? Develop new methods of public safety and national defense that improve our safety and security significantly?
The answer to almost every one of these questions is yes if we decide to focus, work with people who can get them done, and design the implementation system that encourages the transformation. The answer to almost every one is no if current laws, current regulations, current bureaucracies and interest groups are allowed to block the change.
Posing the questions, getting Congressional Committees to hold hearings on the questions, getting the Executive Branch to pursue the questions and getting the news media to cover the questions are the key steps toward creating a transformation just as it was in every previous period.
Proposition 8: The transformation requires a new model of governance which is: entrepreneurial, capital rather than labor intensive, science and technology focused, incentive pulled, success honoring and rewarding, growing small businesses and baby businesses into big successes. In addition, the transformation requires a willingness to coach those seeking to learn (the agricultural agent model), a willingness to prosecute for illegality only those with clearly illegal intent, decentralization, sensitivity to local cooperation and eagerness to be flexible in achieving local success.
Compared with the current bureaucratic, adversarial, unionized, labor intense, litigious, regulatory, one size fits all, penalties and punishment oriented system that criminalizes every day activities; the present system punishes the risk taking and innovative while rewarding the mediocre and the energyless. The transformation in science and technology will require a transformation in government and politics that can be implemented into public policy. The rewards are worth it but no one should underestimate the difficulty.