Why Reform?


Public service sectors world-wide share, rhetorically at least, improvement goals in efficacy, efficiency, quality, safety and sustainability. These reforms have proven difficult to accomplish at any large scale. Witness the repeated structural churn in the United Kingdom National Health System; the continually roiling clouds of acrimony resulting from the United States' 2010 Patient Protection and Affordable Care Act and the continuing controversy caused the abandonment of a federal role in Canadian health care. Governments are realizing that the globally unfolding fiscal crisis has real consequences for publically paid services including health care, education, policing and national defense. Optimizing results from current investments in these sectors is an essential part of sustaining public delivery of services as a social good.

Reform is difficult in the simplest situations because people most often prefer the predictability of the status quo to the unknowns of change. In long established public service sectors significant reform is structurally, culturally and emotionally close to impossible. But it is also required if we are to sustain public access to these public goods.

In the next few posts in this series we will examine the health care case to exemplify the stakes involved on both sides.

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