The Process and Politics of Federal Decision Making

Abstract

THE PROCESS AND POLITICS OF FEDERAL DECISION MAKING THEODORE COOPER* AND NICHOLAS A. OUMPIOi Many of us seem to be unnaturally interested these days in the making of public policy and public policy decisions. It is unnatural that biomedically oriented academicians resort to these kinds of "administrative activities " only on reaching scientific obsolescence or, perhaps, at the shocking appreciation that progress is independent of our own technical contributions. The fact is, however, that the main reason we have become so interested is that we feel threatened. Thirty years ago we would not have felt threatened, because we were not used to dependence on the federal government for support of our intellectual activity. Fifteen years ago we were well funded and lightly regulated, so our intellectual activity was stimulated. I hope it is only the intellectual activity that is in jeopardy, but sometimes we must worry even about our intellectual integrity: it becomes easy to rationalize a position when the alternative may be desperation or inconvenience. And with dependence on the government has come regulation by the government. Of course we are somewhat bewildered by this sudden challenge to our intentions, our competence, and our integrity. But it was inevitable. Why should we be exempt from such concerns when we draw on federal funds? AU arguments for exclusion are relatively feeble. But regulation has suddenly become more than a nuisance, it has become a burden and in some instances an affront. So even we are reacting and saying, "What's going on here?" "Who is responsible for these situations ?" "Why weren't we consulted?" and so on. From such questions and concerns arise conferences, theses, opposition, and sometimes even action . The worst thing and the best thing about the process of federal decision making is that it is not people-proof. There is nothing more certain ?Dean, Cornell University Medical College, and provost for Medical Affairs, Cornell University, 1300 York Avenue, New York, New York 10021. tSpecial assistant to the dean, Cornell University Medical College, 1300 York Avenue, New York, New York 10021.© 1980 by The University of Chicago. 0031-5982/80/2322-0163$01.00 S158 I Theodore Cooper and Nicholas A. Olimpio ¦ Federal Decision Making than the involvement of people to insure imperfection, irrespective of intentions and innovations. Modern-day Washington is preoccupied with fixing things in the health arena. This preoccupation is based on the conclusion which government people have reached that most everything nongovernment people do is wrong, or badly done. "Ifonly they were as smart as we are" is a prevailing attitude. It is particularly acute in the newcomer and those with too much time on their hands. It is a condition which can be observed in political appointees who go to Washington to what are called "policymaking" positions. The clinical syndrome can be easily detected. A certain arrogance is followed by feelings of inadequacy and inferiority. The defense reaction is either hostility followed by change of personnel, or inactivity. In either situation the result is usually a decrease in productivity . The cycle for production and evaluation is short, usually two years, occasionally four. Survival and postgovernment position depend on two things—"doing something" and making contacts. Doing something in Washington is called Making an Initiative. So new teams or individuals always feel obligated to make initiatives rather than progress. Are initiatives important? We certainly need new ideas, but we also need stability. In many ways the bureaucracy attempts to provide continuity to the process, but changing signals from on high tend to confuse those in the trenches. That may be why the so-called bureaucracy is not as resilient as it should be. Of course, members of the bureaucracy are endowed with some of the same characteristics as those who "come to save." They have interests and goals as well, which further mucks up the process. There is a personal need to leave behind a legacy of accomplishment , stamped with an individual signature. One cannot do that if one uses a predecessor's idea. A substantive, doable plan is in fact difficult to formulate and carry through the federal system because of the diverse opinions and biases of the individuals and groups, professional and nonprofessional...