Obamacare, Universal Credit, and the Trilemma of Public Services

Date01 March 2014
Published date01 March 2014
Daniel Béland holds the Canada
Research Chair in Public Policy in the
Johnson-Shoyama Graduate School of
Public Policy, University of Saskatchewan.
E-mail: daniel.beland@usask.ca
Philip Rocco is a PhD candidate at the
University of California, Berkeley.
E-mail: procco@berkeley.edu
Alex Waddan is senior lecturer at the
University of Leicester.
E-mail: aw148@leicester.ac.uk
142 Public Administration Review • March | April 2014
Public Administration Review,
Vol. 74, Iss. 2, pp. 142–143. © 2014 by
The American Society for Public Administration.
DOI: 10.1111/puar.12187.
Daniel Béland
Johnson-Shoyama Graduate School of Public Policy, Canada
Philip Rocco
University of California, Berkeley
Alex Waddan
University of Leicester, United Kingdom
Critiques of “inef‌f‌i cient bureaucracy” are a
hallmark of Anglo-American political culture,
so it comes as no surprise that politicians and
journalists have recently been at full volume when
chastising “disastrous” technological fouls both in
the rollout of Obamacare (the Patient Protection and
Af‌f ordable Care Act) and in the implementation of
Universal Credit, a technologically complex U.K. wel-
fare reform, which has exhibited many of Obamacare’s
symptoms (U.K. Parliament 2013).
While this focus on ineptitude is understandable
when government fails, it hides a constellation of
challenges to ef‌f ective public service delivery. Call it
a public service “trilemma”: we now demand more,
we want it for less, and when things do not go our
way, there is hell to pay. In other words, the mix of
increasing demands for public services, austerity, and
a culture of “high-stakes” accountability has made the
governance of public policies increasingly prone to
critical system failures.
First, demand for complex, high-quality public
services has increased. Both Universal Credit and
Obamacare involve not just signing government
checks but up-to-the-minute, client-customized
performance that places intense demands on gov-
ernment for reliable information technology.  ese
programs are emblematic of larger shifts in public
demand for on-time, customized public policies, often
delivered through digital interfaces. As recent polling
data suggest, citizens are aware of customized gov-
ernment services—and increasingly dissatisf‌i ed with
them. Wide majorities of those surveyed in both the
United Kingdom and the United States believe that it
is dif‌f‌i cult to interact with the government, and many
believe that service access through the private sector is
easier (Accenture 2012a, 2012b).
Second, austerity and privatization have, respectively,
decreased the f‌i scal capacity of government to carry
out resource-intensive public policies and increased
the reliance on contracts with the private sector,
creating oversight problems. In the United States,
sequestration decisions reduced nondefense spending
by 15.7 percent in 2013 relative to the 2010 budget,
with more substantial cuts on the way. Overall, 70
percent of the budget savings from the 2011 Budget
Control Act came from cuts to essential government
programs that had strong bipartisan support (Parrott,
Kogan, and Greenstein 2013).  e U.K. auster-
ity program pursued by David Cameron’s coalition
government in 2010 exhibited a similar pattern of
cuts to public services, reducing the budget by nearly
£11.5 billion, which included closing nearly 200
public–private partnerships (Watt 2013). Shrinking
budgets pose risks for managing critical public services
such as emergency response systems, even leading to
system failure in the event of disaster. As research on
Hurricane Katrina shows, austerity also forces cash-
strapped agencies to contract out, which increases the
challenges of oversight and accountability (McConnell
and Drennan 2006).
Finally, accountability itself has taken on a particu-
larly vicious streak. In a climate of conf‌l ict, political
opponents of major reforms have become particularly
adept at using even minor glitches as fodder for loud
critiques of government programs––demanding f‌i rings
and resignations, frequently before all the facts are in.
Harsher accountability practices are also enshrined
in institutional reforms such as Departmental
Strategic Objectives in the United Kingdom and the
Government Performance and Results Act in the
United States.  ese outcome-focused policies––each
the product of a negative agenda aiming to end
government programs––produce perverse incentives
for bureaucrats to hide rather than expose systemic
errors or problems with their work. Over time, these
small problems have the potential to create inef‌f ective
policies that can drift away from their stated goals and
may lead to serious organizational failures (Heinrich
2007; Moynihan 2008).
While governments may cope well when only two of
these forces are working, all three at once can cause
Obamacare, Universal Credit, and the Trilemma
of Public Services

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