PDIA and Obamacare

written by Matt Andrews

Governments often face unenviable tasks that border on the impossible, given particularly thorny political and administrative complexities. Commentators typically deride governments when they fail in their initial attempts to address such tasks. They pen new laws that are less than many had hoped for, and call public agencies inefficient (or worse) when new roll-out mechanisms go slowly or fall apart altogether. Recent experience with the Affordable Care Act (ACA) in the United States is an obvious case in point. No one seems to have an appetite for the struggles government is enduring as it tries to implement this law. We want new websites that perform miracles the first time around, and insurance reforms that solve coverage problems without rocking too many boats. The more we see government muddling in ACA execution the more we criticize it and question the President’s leadership.

This criticism reflects a view on how governments should work that is common in the world of international development, where I do most of my work. Such view reflects a belief in what I call solution and leader driven change (sldc), which holds that policy and reform solutions will work ‘if they are well planned and implemented with strong leadership from the top’. When development initiatives run into trouble, in places as diverse as Argentina, Pakistan and Zimbabwe, sldc believers typically bemoan the lack of leadership and the uselessness of government. They seem to feel that a leader should be able to do all things when armed with a good solution. Any sign of muddling in the process of making or executing change is a sign of a bad solution, weak leadership, or a flailing administration. Success comes from having the right solution at the start and just executing it properly.

This view is extremely problematic. I say this so emphatically because I find exactly the opposite storyline in most of my research examining successful government policies and reforms. The experiences I look at are diverse, ranging from civil rights reform in the United States to growth policies in South Korea and decentralization in Rwanda. Even though these experiences vary a lot, they all involved policy changes that most commentators would call successful—manifesting in more equitable service access, improved economic performance, better public sector performance, and more. I find more commonalities across the cases as well, related to the way they emerged.

Primarily, evidence suggests that these successes seldom (if ever) came about through a clean process where a leader introduced a solution and just forced implementation by edict. Rather, change was spurred by the recognition (by a group of agents) that a problem existed that warranted change; but no one knew exactly what to do. Solutions emerged over time, through many iterative experiments that provided lessons about what could be done and allowed reformers to build support and capability to do more. I call such experimentation ‘purposive muddling’ and see it fitting into an overall process of problem driven iterative adaptation (pdia) that seems more likely to characterize successful change than solution and leader driven change.

I even see purposive muddling and pdia in the story of NASA’s successful lunar missions, which some media outlets portray as a solution and leader driven change initiative (where technical experts simply did what President Kennedy told them to). In fact, the mission involved many agents (and two presidents) and emerged over a number of years; through experimentation that often looked like it was delivering more failure than success. The experimentation looked like purposive muddling that often required more budget than had been provided and required creative administrative solutions that would probably be questioned today. It spawned sad deaths on the launch pad and the messy dismissal of a legendary administrator, but also ultimately led to a number of humans doing the impossible and stepping on the lunar surface.

I believe that governments are still capable of doing great (and impossible) things, and finding solutions to our most complex problems and challenges—like those evident in the health care domain. But they will never do this in a clean, solution driven process that many commentators seem to believe in. Complex policy changes and reforms like those associated with the Affordable Care Act demand messy processes of purposive muddling. These processes can deliver great results if there is space to learn and iterate (which I wonder about with health reform in the USA). We should be grateful whenever political and administrative leaders in government recognize this, and continue to muddle despite the derision their muddling attracts. The governments we should really deride are those that don’t muddle, because they are probably side stepping the complex and demanding problems their citizens face.

This blog post also appeared in the Washington Monthly.

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