Rightsize: Government Budgets in the 21st Century Council of State Governments January 20, 2012 The Government People Want • • • • • • Functional Streamlined Constantly improved Lower- and-lower priced Personalizeable Not just left or right Outline of Presentation • • • • • • Waste is a Terrible Thing to Mind A New Twist An Ounce of Prevention Talkin’ ’bout de-Regulation Providing Some Backbone The Life Raft Waste is a Terrible Thing to Mind Comprehensive Efficiency Reviews • Texas – first in the nation – $4 Billion the 1st year • National Performance Review Clinton/Gore) – $108 billion 1st year • Our experience: Consistently 5% The Basic Approach The Basic Approach Savings Examples • Employ technology to fight Medicaid fraud • Implement Reverse Auctions • Calibrate salt spreaders to reduce road costs • Eliminate most free postage for prisoners • Consolidate agency mail service • Combine duplicative commissions • Consolidate highway pipe types • Require doubled-sided printing • Eliminate blank report pages A New Twist on Human Services • 19th Century Model • “Discovery of the Asylum” – – – – Insane Asylums Poor Houses Orphanages Penitentiary • Year in the State Pen vs. Year at Penn State Corrections • Divert non-violent offenders – Pretrial detention – Misdemeanor reform – Habitual-offender laws (“3 strikes”) • Alternatives to incarceration • Re-entry services • Drug treatment Similar Issues: MHMR, Juvenile Services, Long-Term Care… More Effective Less Expensive • Prevention • Smaller facilities • Promote home- and community-based care • Individually-targeted • Aftercare • Evidence-based Less Effective More Expensive • Intervention arises due to crisis • Overemphasis on incarceration • Especially: Large facility • One-size-fits-all • Inattention to community/family connections Up Next: Education • Distance Learning Technologies – Improve outcomes – Especially for current lower-performers – Will transform role of schools, need for and use of facilities, nature of debate (e.g., vouchers, home-schooling) – Lower cost An Ounce of Prevention • Government intervention usually posthoc – Ideology – False economy • We know better – Policing – Health care Proactive = Cheaper • Fall prevention • Dental checks for expecting mothers • Investment in chronic disease research We Need More Research • Early Childhood Ed reduces downstream costs • What would reduce the costs of Early Childhood Ed? – – – – Parenting Instruction? Book Rx? Get Parents a GED? What’s the chicken/What’s the egg? Talkin’ ’bout de-Regulation • False dichotomy: – More regulation – Less regulation • Best example (as usual): Policing One Regulatory Taxonomy 15% Hostile compliers 30% Hesitant compliers 30% Clueless (‘inhabitants of the parallel universe’) 15% Spontaneous compliers 10% Industry leaders Cheaper Regulatory Strategies • Performance Tier • Netherlands • Compliance (instead of enforcement) • British Commonwealth • WA State • Target bad actors • IRS • Wisconsin Providing Some Backbone Providing Some Backbone “A few of the things we use the most are the ones we love the least, like Facebok, which according to ForeSee Results holds an approval rating close to that of the IRS.” BusinessWeek 8/16/10 Government as Backbone • Post Office – Public Apps: Package services – Private Apps: Ad/coupon packages • Public Employee Health Care Plans – Private apps on public background: • FEHBP • Connecticut municipal pool • Health exchanges? • A Counter-Intuitive: Public Pensions? The Life Raft • Cut services or raise taxes? • Grandparents or grandchildren? • Public vs. Private? • ROI Questions? ? ? ? ? ? ? ? ? ? Public Works LLC www.public-works.org