Will public opinion kill health care reform in the US? Naturally, I don't know the answer to that question. What is interesting is how a reform process that appeared close to conclusion can wobble mightily upon the apparent signaling of public displeasure. If reinforces once again the centrality of politics - and of public opinion- to processes of reform. What matters now, as the leaders of US government grapple with how to conclude or abandon the reform effort, is to reflect on some of the lessons coming out of the process at this point that might be applicable to reform processes generally. The following seem fairly clear:
The World Bank is pursuing an ambitious program of reform to enable the institution to become more efficient and effective while also gaining more legitimacy among the developing countries that it serves, Bank President Robert Zoellick said today.
In a speech at the start of the World Bank-IMF annual meetings, Zoellick said the World Bank’s reforms would focus on improving development effectiveness, promoting accountability and good governance, and continuing to increase cost efficiency.
“To serve the changing global economy, the world needs agile, nimble, competent, and accountable institutions,” Zoellick told the meeting of the Board of Governors of the World Bank Group. “The World Bank Group will improve its legitimacy, efficiency, effectiveness, and accountability, and further expand its cooperation with the UN, the IMF, the other Multilateral Development Banks, donors, civil society, and foundations which have become increasingly important development actors.”
An instructor in Law School was the first to explain to me the nature of 'deal anxiety' as a problem for business; now I know that it is a problem for governance reform as well. For a lawyer 'deal anxiety' manifests when a client - usually a business executive - is so anxious to close a business deal she ignores the need for her attorney to exercise due diligence over the contract. For instance, what happens if there is a dispute? What dispute resolution mechanisms might be needed? What about conflict of laws if it is an international contract? Are we going to use the laws of the domicile of Party A or Party B? And so on. You'd be amazed how many business leaders just want to shake hands on the deal, and get on with 'the real business of making money', until something goes wrong and both sides reach for their lawyers ...as cowboys reach for guns. Then you have a shoot out.
In international development, 'deal anxiety' manifests as the pell-mell rush to get a (reform?) project going. Whether in grant making donor agencies or in multilateral lending institutions there is a tendency to rush to close the deal, get the partner government to sign the relevant documents, get the internal approving authorities to say Yes. The attitude is: Let's keep this moving folks!
The World Bank released its annual Doing Business report (pdf) last week which tracks regulatory reforms for conducting business and ranks countries based on their ease of doing business.
Countries are evaluated and ranked by indicators such as starting a business, employing workers, getting credit, paying taxes, etc.
In South Asia, seven out of eight (75%) of the countries instituted reforms that were conducive to business, higher than any previous year of the study.
Pakistan was the highest ranked country in the region at number 85 while Afghanistan and Bangladesh were the most dynamic reformers with three reforms each. Afghanistan’s rank in the study also increased the most in the region, climbing eight spots.
In today’s fast-paced digital environment, new forms of literacy are quickly emerging. It is not only a challenge to keep up with new tools and skills needed to stay informed and engaged in the world around us, but also to find the time and resources. While media literacy is not a new issue, it has quickly become an eminent one due to the fast speed and wide spread of information via new media technologies. As a matter of urgency, the European Commission has issued a new recommendation, pushing its member countries to make media education available to all citizens and include it as mandatory in the school curricula, as well as adopt media literacy as a key pre-requisite for active citizenship. While internet penetration is high in Europe, there is an evident skill gap between citizens of different age-groups and socio-economic backgrounds in using the internet and new technologies. The European Commission believes that this skill gap and media illiteracy can lead to missed opportunities and social exclusion, and therefore, it’s important to instill media literacy skills in all sections of society. One could possibly also argue that citizens would also be excluded from realizing their political rights. The Commission further suggests that media literacy would be “a stimulus and a pre-condition for pluralism and independence in the media”, leading to multiple perspectives and diverse opinions that will enrich public discussions and specifically, lead to “a positive impact on the values of diversity, tolerance, transparency, equity and dialogue.”
As readers of this blog will have realized, we have been watching with keen interest the effort to reform the health care system in the United States in order to pull out generalizable lessons for reform efforts elsewhere. As you must also know, over the month of August that reform effort ran into some turbulence, with lively town-hall meetings, and the rise of a blocking coalition. The outcome remains in the balance as I write.
Now, other students of the process have offered one explanation of the current challenges faced by this particular reform effort. They say that much of the effort concentrated for a long time on the Inside Game, that is getting the United States Congress to act, and keeping the discussion within authoritative state institutions. According to these observers, reformers ignored the Outside Game...building a reform coalition within the broader society, and shaping public opinion. That supposedly gave opponents of reform the chance to build what they hope will be a blocking coalition, frame the reform effort negatively and so on. These observers believe that the Outside Game is now on, but some damage was done.
Technical specialists like to name social problems using the language of their disciplines, and of whatever narrow policy community they belong to. What they often forget is that to secure broad support within the relevant political community how you define the problem that you are asking society to focus on and do something about matters. It matters a great deal. In fact, it can be the difference between getting the attention of legislators and broad publics or having your issue ignored.
For a live example consider the current efforts to implement health-care reform in the United States, something that presidents have been trying to do for about 50 years. Let's ask: What's wrong with America's health care system? What needs to be fixed? In other words what is the definition of the problem?
The outbreaks of political turbulence around the world have prompted me to re-visit Edmund Burke's masterpiece, Reflections on the Revolution in France ( 1790). In the work, Burke attacks the French Revolution. I remember that when I had to write a term paper about the work in a class on the History of Political Thought in graduate school, I fully expected to hate the Reflections and to debunk it. But it amazed me, and impressed me. First, its eloquence is overpowering. Even now as I leaf through my old copy, the grandeur of the language still moves the spirit. Second, you cannot but be impressed by the prophetic power of Burke's analysis of the French Revolution. For he wrote the Reflections in the early days of the Revolution, yet he was able to correctly predict its path - the deepening violence, the collapse into dictatorship. Now, as a school-boy fan of the French Revolution that got my attention.
Again, Uruguay shows that when civil society intelligently promotes coalition-building and finds sympathetic allies in government, media reform is possible. On June 10, the Congress passed a bill to reform the Penal Code and the Press Law. The new law will abolish libel laws and subject national legislation on communication issues to criteria enforced by the Inter-American Commission of Human Rights. The bill is likely to be approved by the Executive.
This achievement is another landmark of recent efforts towards media democracy in Uruguay. During the past two years, legislation on community broadcasting, access to public information, and national archiving of information was approved. The passing of community broadcasting law in December 2007 represented a major success. The law assigns one-third of radio frequencies to community, non-profit stations. It defines community stations in terms of the nature of their goals (“social mission”) and ownership (“collective properties”) rather in terms of reach or geographical location. It stipulates the existence of the Consejo Honorario Asesor de Radiodifusión Comunitaria, a multi-sectoral committee with significant representation from civil society that oversees the bidding process and monitors the performance of stations to ensure that they meet social goals. The passing of the “freedom of information” law in October 2008, and the elimination of libel and contempt laws are other positive advances. This is encouraging if we consider that, like in the rest of the region, the dominant media system historically conformed with the norm of media policies in Latin America: state patrimonialism and collusion between governments and large business.
It is important not to let a scandal go to waste. If you follow world politics, then you must know about the recent events in Great Britain. According to the Financial Times, 'For the past two weeks, Britain has been in a state of stupefied anger at the ingenious ways in which elected politicians have used their expenses system to milk the taxpayer'. As a result, says the same report, 'public fury over scandalous expenses claims has pushed lawmakers, in fear of losing their jobs and their reputations, towards constitutional reform'. (Financial Times, May 23/May 24 2009.)
Now, I am a student of the constitutional thought of Jeremy Bentham (1748-1832), the British utilitarian philosopher and jurist. Thus, as I have followed the scandal Bentham's words have been ringing in my ears. For, one of the great battles of Bentham's long life was the reform of parliament. But Bentham was a universalist. He was confident that his ideas for constructing a form of government that would provide 'securities against misrule' were universally applicable. Bentham believed that government should be as open and as transparent as possible. This is his Panopticon principle, all round transparency with very few exceptions. Note that a request under the Freedom of Information Act got the scandal under discussion going.