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Henry David Thoreau had decidedly mixed feelings about the railroad that reshaped America during his lifetime and, quite literally, shattered the tranquility of his Walden Pond cabin several times a day. “We do not ride upon the railroad,” he groused in Walden, “it rides upon us.” He relented, at least a little, elsewhere in the essay: “‘What!’ exclaim a million Irishmen starting up from all the shanties in the land. ‘Is not this railroad which we have built a good thing?’ Yes, I answer, comparatively good, that is, you might have done worse.” But his opening turn of phrase offers an apt point of departure for this chapter. A nation builds railroads and that network, from that point forward, builds the nation. This is true for both nations, but in a simpler and more dramatic way for the United States, which matured in tandem with rail transportation.
Few, if any, areas of endeavor show a more complicated, and more consequential, tangle of publicness and privateness than health care. It is a prominent, but for the most part, poorly performing arena of public–private interaction in the United States. The governance of this vital sector of the economy – more than one-sixth of GDP – is collaborative; public funds pay for roughly half of medical services (with most of the private spending subsidized through tax preferences), while the vast majority of providers are private. America’s public leaders often fail to recognize the dynamic of shared discretion at the heart of the health-care system, and this failure contributes to the private sector delivering care that is less effective, affordable, and accessible than it should be.
Any culture’s human potential for work and wisdom accounts for a significant share of its resources. Developing that potential – a process termed education, training, or human capital development – is a major responsibility of government. Spending for human capital development, using a conservative definition, averaged 5 percent of gross domestic product (GDP) for all Organization for Economic Co-operation Development (OECD) countries, in 2015. In most rich countries, education comes second only to health care as a claim on public spending, as it does in the United States, at 6.1 percent of GDP.
Early in this book, we describe the cycle that successful collaboration requires: analyze, assign, design, and assess (AADA). The chapters that followed dissected the experiences of China and the United States in using, misusing, or mistakenly not using collaborative governance across a broad spectrum of policy areas. Those accounts reveal, for both nations, many successes and more than a few failures. The successes tend to occur when collaborators devise by creative effort, or improvise by trial and error, the proper alloy of public and private responsibilities and the proper sharing of discretion. In many cases, reassuringly, initial failure is the overture to later triumph; when one set of arrangements works badly, collaborators try again.
One stormy night in our species’ long prehistory, somebody got tired of sleeping in the rain and couldn’t find a cave. She leaned a well-leafed broken branch against a big rock, or maybe bent a low-hanging bough to the ground, weighted it with a stone so it would stay put and crawled in out of the worst of the weather. This unnamed innovator slept a little drier that night, and in the process invented real estate. Fossil evidence makes it clear that that this happened 30,000 years ago at the very latest, though humans may well have been building shelters as early as they started wearing clothes 140,000 years before that.
For roughly a millennium in ancient Greece, pan-Hellenic athletic competitions were held in Olympia every four years. With an eye to resurrecting the Games, the International Olympic Committee (IOC) was formed in the late nineteenth century and the first modern Olympics were held in Athens in 1896. Since then the Olympics have taken place at regular four-year intervals, with time out for a couple of world wars. In the mid-twentieth century, winter competitions for cold-weather sports were added, first as an adjunct to the long-standing warm-weather competition and then as a separate event held in a different city and on a different quadrennial cycle from the Summer Games.
Dragons – as befits a mythical species – are diverse. In the Western tradition, unlike the East, dragons are terrifying, fire-breathing brutes. Even within the West they differ, particularly in size. In virtually every self-respecting European city there is an art museum with some version of a medieval St. George and the Dragon. The saint tends to be pretty similar from country to country. But the dragon’s scale dwindles dramatically from the south to the north of Europe, ranging from whale-sized in Spain or Portugal to something more like a middling Doberman pinscher in Norway or Sweden. The Chinese dragon is a different beast altogether – sinuous, intelligent, dangerous to be sure but not without a quotient of benevolence. In ancient mythology dragons bring the life-giving rain; droughts result when dragons aren’t properly respected. As China surged to renewed global prominence in the late twentieth and early twenty-first centuries, it at times resembled the Western dragon with its intimidating roars and the latent risk of conflagration.
Collaborative governance (CG) can outperform other ways to pursue public goals in important circumstances. The conceptual framework developed in this chapter identifies those circumstances and defines the principles and design features required for success. The chapter then examines some salient elements of the Chinese and US context that shape adoption of the collaborative approach in each country.
Five straightforward diagnostic questions define where and how CG should operate. First, should some missions involve government at all, rather than being left to private parties? If the answer is “no,” then we’re done – at least for the purposes of this book. Second, if the answer is “yes,” should the government produce the service itself, or should it delegate production (in whole or in part) to the private sector? Third, for functions that should be delegated, how should that delegation take place?
The governments of China and the United States - despite profound differences in history, culture, economic structure, and political ideology - both engage the private sector in the pursuit of public value. This book employs the term collaborative governance to describe relationships where neither the public nor private party is fully in control, arguing that such shared discretion is needed to deliver value to citizens. This concept is exemplified across a wide range of policy arenas, such as constructing high speed rail, hosting the Olympics, building human capital, and managing the healthcare system. This book will help decision-makers apply the principles of collaborative governance to effectively serve the public, and will enable China and the United States to learn from each other's experiences. It will empower public decision-makers to more wisely engage the private sector. The book's overarching conclusion is that transparency is the key to the legitimate growth of collaborative governance.
Ordeals are burdens placed on individuals that yield no benefits to others; hence they represent a dead-weight loss. Ordeals – the most common is waiting time – play a prominent role in rationing health care. The recipients most willing to bear them are those receiving the greatest benefit from scarce health-care resources. Health care is heavily subsidized; hence, moral hazard leads to excess use. Ordeals are intended to discourage expenditures yielding little benefit while simultaneously avoiding the undesired consequences of rationing methods such as quotas or pricing. This analysis diagnoses the economic underpinnings of ordeals. Subsidies for nursing-home care versus home care illustrate.
For decades, the U.S. Air Force has contemplated replacing the A-10 Thunderbolt II “Warthog” with a newer fighter aircraft. However, a quantitative analysis comparing the Warthog’s performance and costs with those of its intended replacement, the F-35 Lightning II Joint Strike Fighter, shows that retiring the Warthog would be operationally unsound and fiscally imprudent. The rationale for the replacement is that it would increase airpower capability while controlling costs. That rationale does not withstand scrutiny. An effectiveness analysis based on results from a survey of joint terminal attack controllers indicates that the A-10 vastly outperforms the F-35 in providing close-air support (CAS), a critical requirement for future conflicts against terrorists and insurgents. A cost analysis demonstrates that replacing the A-10 before its service life ends in 2035 would cost at least $20.9 billion. The replacement plan would waste substantial resources and seriously impair U.S. military capabilities. Given that constrained future budgets and low-intensity conflicts requiring precision CAS can be expected, the U.S. air fleet should include the A-10 Thunderbolt II.