Disturbing is maybe an understatement. The incentives are all wrong. When the incentives become perverse, bad things happen.
Nursing used to be about helping people recover. And then Covid canceled large swaths of recoverable hospitalizations and nurses watched as earlier Covid hospitalizations and deaths crowded their day—non-stop ventilation and/or death.
Remember the medical dramas on TV or maybe your own drama? Nurses, both female and male wore uniforms that were both attractive and reassuring. Now they often are garbed in hazmat gear. Nurses are eager to help, not assist in undertaking. Many, it is reported, have chosen to leave the profession. While not a forecaster, it seems to me this portends a generational move that will leave health care the poorer.
Similarity the incentives in politics or what is actually public affairs have also changed and certainly for the worse. There was a time some decades ago that I considered running for Congress. Today I wouldn’t accept an appointment to serve.
Public-minded people are needed. Too often what we get today are people who want to serve dogmatism or a cult figure, not the public. Progressives have their Squad; Republicans have their own version of cancel culture. The latter scream that academics cancel conservative views (and often they are right); on the other hand, the former President cancels with the acronym RINO (Republicans in Name Only). What he means is to be a Republican you have to support me.
This cancellation recalls President Biden asserting that “if you are Black you can’t be a Republican.” What both Parties nominal leaders want to cancel is common sense.
Business in America is always searching for the new thing. It might be an invention. Or carving out a new product or service segment. Or significant changes in customer service. The one thing the customer can depend on is some level of change, until. Until a segment of service becomes monopolized.
Health care, the dominant political parties and government are to a large degree monopolized. And too often the patient or the taxpayer is left frustrated. Frustrated by stupidity, inefficiencies and poor service.
We are told that future pandemics should be expected. Health care leaders need to examine the evidence, and if it is convincing, invest in scalable infectious disease centers that can deal with lethal infections without closing down care for cancer or cardiac or other needs that are crucial to well-being. Covid 19 has served up lessons; we should now use time to advantage .
When it comes to public affairs, the largest plurality now register as Independent. Recognizing this shift, several forward-looking States have recently enacted rank choice voting or open primary laws. Both selection methods tend to defang the rabid. Rank choice voting, for example, incentivizes more expansive outreach by candidates as second place selections, when no candidate gains a majority, are crucial. Open primaries allow voters to cross Party lines.
Incentives matter. Public affair leaders should be constantly revisiting incentives. If health care disincentivizes nursing, change it. If political cancel culture discourages public spiritedness, change it. And beware of private and public monopolies; if there is only one source for service it is likely to be bad.
Al Sikes is the former Chair of the Federal Communications Commission under George H.W. Bush. Al writes on themes from his book, Culture Leads Leaders Follow published by Koehler Books.