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View from the Cordillera

A Commentary on Achieving Excellence in Local Government
Read by Municipal Leaders on 4 Continents
Published by the Cordillera Institute
(Vol. 4, Issue 30)
The Health-Care Dilemma (part 4): Making Real Reform a Reality
To order the full text of this commentary or to become a subscriber, see the notes below.

Summary of This Commentary
From time to time when I write something critical of senior government, there will be complaints from some newer readers.  This series on health care is no exception.  One reader used the quaint expression 'toadies' for business when referring to our analysis of current health-care systems.  When someone implies anti-government bias, I remind them of the mission of our Institute — to advance the achievement of excellence in local government.  If we were an anti-government organization, why would we be dedicated to the achievement of excellence in any branch of government?  And, why would we be advocating the creation of more local governments?  That said, there are roles in society where the private sector has some inherent advantages over government — just as there are other roles where the inherent advantages rest with government.  However, when any organization — whether in the public or the private sector — is performing poorly, criticism of the offenders should not be taken as a condemnation of all.  For the same reason, praise for a specific organization should not be taken as an endorsement of all.  As to our choice of whether a given activity should be performed by government or by business, we recommend that governments — whether local or senior — use a process of managed competition to make that choice.  [For more on managed competition, see Issues 01.14 and 02.14.  You will find the summaries of those commentaries here.]

In the previous issue, I noted that meaningful health-care reform will remain no more than a concept for most of us — unless we see how it can become a reality in our own countries.  In this issue, we address that challenge.  Most of our western democracies have at least studied the question of reform.  There have been committee hearings, blue-ribbon panels, royal commissions, and detailed reports.  Sometimes, those efforts were attempts to lend credibility to reforms which the government had already decided to make.  Other times, hearings or studies were just an attempt by the government to delay taking action.  If either of those scenarios describes the situation in your country, the public will likely be wary of any change — even change for the better.  Still, that's no reason not to make the effort.  The good news is that there are others who have taken the plunge and succeeded.  Keeping that in mind, what other challenges are there?  How can these challenges be overcome?  How many classes of care are there?  What other information is needed?  How accountable is the system?  Is the system sustainable?  What can local government do?  Answers to these important questions — and more — are provided in this issue.

As always, we welcome your comments.

David Barber
Director
Cordillera Institute
(416) 293-9300
CordInst@istar.ca
http://pages.istar.ca/~cordinst/



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About This Publication
Each issue of View from the Cordillera covers some aspect of excellence in local government.  It may examine one of the success elements; it may present a case study; it may introduce a resource (an individual, a group, a publication, etc.) which is advancing excellence; it may advocate a new direction for local government; or it may identify a wrong turn in public policy and offer an appropriate remedy.  This electronic publication is read by those who govern, manage, support, and sustain our local governments.  For more information, just click on the About VFC button below.

About the Cordillera Institute
The Cordillera Institute is an independent research and public policy organization dedicated to excellence in local government.  Since our founding in 1994, we have studied many high-performance organizations to learn what makes them successful.  From this research, we have distilled a set of principles, paradigms, policies, programs, and practices which are the key elements of their success.  Our mission is to be a catalyst — to empower municipalities, school boards, public utilities, and other local public agencies to achieve excellence by adopting and applying these success elements.  For more information, just click on the About CI button below.

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