STUDENT: Good afternoon.
My name is Jenna Troup, and
I'm a Master's Candidate
in the Social and Behavioral
Sciences Department,
and a member of the Harvard
School of Public Health
Women in Leadership
Student Organization.
I'm excited to be here today
to introduce Elaine Kamarck.
She's a public sector scholar
with extensive experience
in government,
academia, and politics.
Dr. Kamarck is a senior fellow
in the Governance Studies
program at the
Brookings Institution,
and the founding
director of the Center
for Effective Public Management.
She's also senior
editor of FixGov,
a blog focused on
discussing and proposing
solutions for domestic political
and governance challenges.
Most recently she's the
author of How Change Happens--
or Doesn't: The Politics
of US Public Policy.
The book explores
transformative changes
in the space where politics
and policy overlap,
and asks why some policies
succeed while others fail.
Prior to her current
positions she
was a professor at the Harvard
Kennedy School of Government
where she taught
courses for 15 years.
She was also a senior
staffer in the White House
from 1993 to 1997, and
created and managed
the National Performance
Review, which
was the largest
effort at government
reform in the second
half of the 20th century.
In the 1980s she helped to found
the new Democrat movement that
resulted in Bill Clinton's
election to the presidency.
She has a Ph.D.
and Master's degree
from the University of
California Berkeley.
Before I turn the session
over to Dr. Robert Blendon who
will be moderating
today, please join me
in welcoming Dr. Elaine Kamarck
to the Harvard School of Public
Health and to the Voices from
the Field leadership series.
JENNA TROUP: Jenna, thank you.
We're going to have
a bit of fun today.
Elaine is an old friend.
And secretly
Elaine's lived a life
that an awful lot of students
here would love to do.
She's been in politics,
public policy, academics,
in the White House,
taught students,
gave advice to
presidential candidates.
And since we're friends I'm
going to ask her about her life
and how she did this.
So first is, I've got to know,
did you think about this role
when you were an infant?
How did you come to this?
This is not the traditional
role that people play.
Tell me how we got into this
incredibly-- really five
different type career roles.
ELAINE C. KAMARCK:
Well when I was
little girl I wanted to be
a princess just like most
little girls actually
still want to be.
So that wasn't the case.
However my dad worked for the
Social Security Administration.
And my first memory
of my father's job
was that he worked
for the government,
and that was a good thing.
I was 15 years old before I knew
that not all pens had written
on, property of US
federal government,
as the pens in my house had.
And Dad got a big promotion.
He was probably in his,
I don't know, early 40s.
I was a teenager.
And we moved from
upstate New York
to Baltimore, which is
the headquarters-- still
is-- of Social Security
Administration.
Because this was 1965,
Medicare had just passed.
So my dad was one of
a team of young men
who were called upon
to write the training
manuals for Medicare.
So they could train the
thousands and thousands
of people in the Social
Security Administration
how to sign up people
for Medicare and Medicare
eligibility.
And he used a new science
of learning at the time
called program learning where
you-- I'm sure that we still
use it, right-- where
you read a paragraph,
then you answered a question
about the paragraph,
then you read in paragraph,
answered a question.
In order to see if he
was doing this right,
and he was writing in
a simple and clear way,
he tried out his writing on me.
So I think it's fair to say
that I was the only 15-year-old
in America who could calculate
Medicare benefits in 1966.
So my introduction to
politics and government.
And I was always
interested in it.
And part of it was the
lessons in my home.
ROBERT BLENDON:
So tell me how you
moved from the academic role
and public policy to politics.
And you really did.
It wasn't a matter of, I'm
going to watch you, study you.
But, in fact, you
were a major figure
in setting up the politics
of all types of policies.
How did you decide
to bridge that gap?
And how easy was it to do?
ELAINE C. KAMARCK: I
went to graduate school
in political science.
And then we moved to Washington.
And I sat at home starting to
write a doctoral dissertation.
And that just seemed
a little boring.
ROBERT BLENDON:
That's [INAUDIBLE].
My doctoral dissertation
didn't lead to your career.
So I was very interested to
how you made that happen.
ELAINE C. KAMARCK: So I
dropped my dissertation.
OK?
I dropped my
dissertation and went
to work for the Democratic
National Committee
when Jimmy Carter was president.
And they were running what
was a series of party rules
commissions.
And I found myself in one of
the most interesting nomination
races in recent
American history.
I found myself, at 30, in
the middle of the Kennedy,
Carter fight for the nomination.
And with a bunch
of other people.
Tom Donilon, who just left as
the National Security Advisor
to Obama.
A lot of us cut our political
teeth in that nomination fight.
And I certainly left my
doctoral dissertation behind,
and didn't even think
about it for a couple
more years, because
politics was so exciting.
However in 1980, after that
fight, as you may remember,
Ronald Reagan won the
presidency and the Republicans
took the Senate.
So I then discovered that I had
no job, and being a Democrat
was unlikely to find
a job because there
weren't any jobs for Democrats.
And so I actually sat
down, and went back,
and wrote my dissertation.
And of course I wrote it
about nominating politics.
And I also, though,
had to do something
which is apropos
of my recent book.
I couldn't write a dissertation
just about the Democrats.
If it was going
to be legitimate I
had to write about
the whole system,
and both political parties.
I met a guy named
Lee Atwater, who
was George Bush's famous
political operative.
And he was sympathetic
since he was also
ABD in political science from
University of South Carolina.
And he opened up the
Republican Party for me.
And I got to know
lots of Republicans,
a couple of whom are
still friends of mine.
I got to know this
other world, which
was the world of conservatives,
of Republicans, people who
worshipped Dwight
Eisenhower, not Jack Kennedy.
It was like being an
anthropologist going
into a new world.
So I wrote my doctoral
dissertation then
10 years after leaving
graduate school.
I had three children
by that time.
I was a suburban mom.
But I actually finished
my dissertation.
So I really went
back and forth a lot.
But I didn't really become
an academic, frankly,
until I came to Harvard in 1997.
I was a part time academic.
ROBERT BLENDON:
So I want to move
into reinventing government.
First of all, that
came out of a period
when we saw huge distrust
in government in general,
in the [? world of ?] public.
So is this a Clinton,
Al Gore idea?
This idea of actually trying to
figure about how you could make
government work in a way that
people would feel better.
Does that go back to your
father making Medicare work?
Or where does that come from?
ELAINE C. KAMARCK:
Reinventing government
was part and parcel of the
New Democratic movement
that we began in the late
'80s through the Democratic
Leadership Council, now defunct.
And Bill Clinton was the
chairman of that group.
So we were doing
this simultaneously.
And essentially
the goal of the DLC
was to fix the problems of the
Democratic party at that time.
So to give you an idea how
severe the Democratic Party's
problems were, we
were in the middle
of a crime wave, an
unprecedented crime
wave in American cities.
And the Democrats were
perceived as the party
of the criminals,
not the victims.
Not a good place to be.
OK?
So we had a lot
of things to fix,
including this massive
distrust of government.
So a guy named David Osborne,
who's one of our neighbors
here in the Boston
area, had written
a book called
Reinventing Government.
Clinton read it.
We get the DLC publicized it.
And Clinton knew-- he's a
very intuitive, brilliant
politician-- he knew that just
as reforming welfare, cracking
down on crime, and
reinventing government
were the sorts of
things that were going
to fix the image of the
Democratic party, which at that
point was a party that was
seen as really out of step
with the mainstream of America.
Fast forward, by the way,
and a lot of these things
can be said about the
Republicans today.
But we come back to that.
So it was really part
of his campaign promise.
I saw him in New Hampshire.
He went from place to place,
town hall to town hall,
talking about
reinventing government.
And it was very important
that it was reinventing,
because as a Democrat he
couldn't be against government.
Right?
He wasn't going to be
against the party of Franklin
Roosevelt.
But he knew that Americans
were looking for a change.
And that's what he
meant when he talked
about it in the campaign.
ROBERT BLENDON: So how do you
actually make that happen?
ELAINE C. KAMARCK: Well
that was the problem.
Right?
Then we got into
the White House.
Then we got in the
White House and we
had to day, OK what
does this mean?
Right?
What does this mean in
the federal government?
And the first briefing I
ever did with the President
a Vice President I wanted to
set the magnitude of the task.
And I said, Mr. President,
there are more federal employees
than there were people
in the state of Arkansas.
And Mr. Vice President,
the federal government
is in control of
more real estate
than the state of Tennessee.
That's how big this thing is.
And so we were going
to have to really spend
some time figuring
out what was wrong.
We had a lucky break
in that we were
sort of operating
simultaneously with the advent
of the internet.
When I went into the
White House in '93,
literally we didn't
have computers.
OK?
We had push button
telephones and no computers.
By '96 we were online, although
the Secret Service would not
let us hook up to the internet
because it was a security
breach.
They didn't know how to protect
the President's schedule.
So we couldn't use the internet.
In fact, it wasn't until I
came here to Harvard in 1997
that I ever surfed the web,
because in the White House
that was verboten.
But we were able to see the
potential of the technology.
And we were able to
start taking, as we moved
through topics in
the government,
we were able to use
the new technology
to increase our productivity.
And so we were able to deliver
the smallest government
since John Kennedy
was president.
We were able to downsize
in the military.
We were downsizing bases.
We did a lot of re-engineering.
Everything from the
Internal Revenue Service
to the Veterans Administration.
And we're very proud
of the fact that if you
look at that trust in government
score you talked about Bob,
it starts at 17% in 1993.
By 2000 it's at 44%.
And we think that we
just were working,
and working, and working to
say to the American people,
we are trying to give
you value for money.
ROBERT BLENDON: OK.
You have a lot of people
running federal agencies
at that time who may or may not
be as enthusiastic about this
as you are.
Are there some
lessons here about how
you get-- As someone who
chaired a department,
the thought of downsizing
really was not as exciting to me
as it might have been to Elaine.
So how did you get
them all so excited
about being smaller and leaner?
ELAINE C. KAMARCK: Yeah.
Well that was hard, Bob.
That was hard.
And especially after 12
years of Republicans.
Right?
All the Democrats came in
and they wanted to expand.
They wanted bigger,
more, and more, and more.
A couple things.
We did it with the carrot
and with the stick.
All right?
The carrots were that this was
a high level administration
priority.
And the President
talked about it,
the Vice President
talked about it.
People knew that
big was not good,
that the era of big
government was over,
as Bill Clinton had said.
So they knew that if they
wanted to be on the same page
as the President-- which
most people did-- that
rather than expand, they
ought to hold the line.
The ought to try
to hold the line.
The second thing was, we did
have a technological revolution
going on.
And this, in fact, allowed
for a lot of efficiency.
So a lot of the downsizing that
occurred during this period
was literally
information technology
coming in and doing
things that used
to have thousands
of clerks doing.
And those were sort
of the carrots.
The stick was, we used
OMB personnel caps.
We just placed the caps
on the agencies and said,
you're having this many FTEs.
That's it.
Sorry Charlie.
And we had to do that as well.
So we did the carrots
and the sticks.
And we had huge
reductions in personnel,
which did not go
back up, by the way,
until after 9/11, where the
increases then were made up.
But it was all on the
national security side.
ROBERT BLENDON:
So strategically,
are there some lessons that,
if you were giving someone
else advice doing this,
that you'd give them?
ELAINE C. KAMARCK: Yeah.
First of all, leadership
really does matter.
So having the president care
about the issue matters.
And in fact, since then
we've had two presidents
who sort of say they care,
but don't in a systematic way.
Secondly, we had expertise.
So leadership matters.
Expertise matters.
We built an initial team of
400 seasoned civil servants.
I was the political
head of this.
But I had leading the effort
three men who between them had
almost 100 years of
government service.
They knew where
everybody was buried.
When I said, look I want
so and so to come and work
for the federal
government-- we had
no appropriation, by the way.
We had no act of Congress,
no appropriation.
We spent millions of dollars.
How did we do that?
Oh, they'd say, well yeah you
can use the Intergovernmental
Personnel Act.
We'll get that done.
They knew how to make
this monstrosity,
the federal government, work.
I had computers, telephones,
travel money, personnel,
et cetera with no appropriation.
OK?
And it was because they
knew how to borrow, and use
equivalencies within
the federal government.
We recruited these 400
people, made them into teams.
ROBERT BLENDON: That
was my next question.
How did you find them?
ELAINE C. KAMARCK: OK, well
here's the interesting thing.
There's a picture on my
wall of my office of Al Gore
and I in April.
The cherry blossoms
are out, et cetera.
And that was the
day that he told me
that we need to have
our team recruited.
So we rushed, and rushed, and
rushed to recruit the team.
And what we got was
the federal government
giving us their turkeys.
So every office
that had a person
who was completely dysfunctional
and they couldn't fire,
they sent them to us.
So for the photo op on
April 15 we had a full team.
We then had to spend the
next two months getting rid
of the people who were
not the right mindset.
Because the mindset had to be,
they had to be an innovator.
They had to have ideas.
And they had to have
a passion for change.
Because most of the
passion in a bureaucracy
is for holding the line.
And we were looking for
people who wanted to change.
ROBERT BLENDON: Let's
open this up for a minute.
It turns out I have 10
years of questions here.
So if you don't have
anything, I'm fine.
But if somebody wants to
get in the middle of this
for a second, does anyone
want to ask a question?
STUDENT: Hi how are you?
Thank you very much
for being here.
My name is Leo.
I'm an MPH student
here at the school.
And you said,
passion for change.
And so my question
is, how do you
engage people who are not really
thrilled about changing things?
And how do you engage
them to movement?
Because we talk a
lot about leadership
here, especially in this series.
And it would be great
to know about you,
how do you actually engage
people to do things?
ELAINE C. KAMARCK: Yeah.
Well there's two ways.
One way is, in fact, you try
to make it in their interest.
OK?
And you try to make
it something that they
see in their interest.
And the other way is, you
just bowl right over them
and ignore them, and
just go around them.
OK?
And organizations do
that all the time.
OK?
They will find a change agent.
There's something called--
Well, a lot of corporations
will have places where
they focus on innovation,
and then they just
implement the innovation.
And the people who
don't like it leave.
A lot of people left the
government when we came in.
There were people that took
their retirement because they
said, we don't like this.
We don't like these guys.
We don't like all
this service stuff.
We don't like the
customer service
proposals they're making.
They left.
So it's a mixture.
Sometimes you can
bring people along.
Leadership matters here,
and persuasion matters.
Sometimes actually you just
do a generational change.
And a lot of times what you
find is the generational change
will do it.
My successor-- I came up here
to Harvard in '97, and a man
named Morley
Winograd took my job.
And somebody once asked him, how
is the federal government going
to operate in the
future when they're
losing all of these
senior people?
And his response
was, how are they
going to manage in
the future if they
keep all these senior people?
So I think everybody
who's been through change
realizes that there is some
combination of leadership
and persuasion, but also
just generational change
and personnel change.
ROBERT BLENDON: Other questions?
Well Elaine, if you were giving
advice to someone starting out
who wanted to
follow in your root,
what would you give
them in terms of advice?
ELAINE C. KAMARCK: Well, OK.
So I'd say there's two things.
ROBERT BLENDON: One has to
be staying at the University
being a professor.
But there probably
is a second option.
ELAINE C. KAMARCK: I think one
is subject matter expertise.
OK?
I think in this day
and age subject matter
expertise is quite important.
On the other hand, a lot of my
colleagues and your colleagues
have brilliant ideas, and they
never see the light of day.
They never get out
of the academic press
or the academic journals.
And I think that everybody
needs to understand politics.
And yet people, they
shy away from it.
They think there's
something dirty about it.
Politics is democracy guys.
We like democracy,
we hate politics.
You don't have democracy
without politics.
Nor do you have democracy
without political parties.
Parties matter.
Factions within parties matter.
We don't govern extra-party.
In fact I can give you a
long list of politicians--
Jesse Ventura, who managed to
get elected as extra-party--
and are big flops.
ROBERT BLENDON: He
was a wrestler in case
you missed that.
ELAINE C. KAMARCK: Yeah.
And he had his
moment in the sun.
But he was quite
ineffective as a governor.
And ultimately ineffective
as a politician.
So I think everybody needs to
just pay attention to parties.
So there's the expertise
angle, the intellectual angle.
There's an emotional angle.
People who care
about public policy
tend to have an emotional
attachment to their beliefs.
And that emotional
attachment then
results in them thinking that
the opposition is somehow
evil, and somehow bad.
Well, maybe that's
the case sometimes.
Usually, frankly, in
democracies it's not.
They're just different.
And you cannot get anywhere
if you don't understand
the opposition.
So just vilifying
the Tea Party is not
going to allow you to
understand what they believe
in, why they believe in it,
what the points of contact are,
et cetera.
And where the potential
agreements are.
But too many people--
and I will include,
by the way, the White
House on this one.
After 2010 they just
dismissed these people.
Oh, they're crazy, they're
radical, they're this,
they're that.
Well the more you talk
about people like that,
the more they decide that
you're crazy and radical too.
OK?
And you get into
this downward spiral.
You really have to be
able to put yourself
in the other person's shoes.
And if you can't
do that, you are--
I don't care how smart you
are, and how many degrees
you are-- you will
not achieve change.
You will not be effective
in moving things forward
in the world.
ROBERT BLENDON: How do you
get experience doing that?
ELAINE C. KAMARCK: Well
you've got to start--
and it's hard in
Cambridge-- you've
got to start knowing people
who are not like you.
OK?
As I say, when I did my
doctoral dissertation,
one of the best
parts of it was, I
had to learn the
Republican Party.
I had to learn their values.
I had to learn that
freedom to them
is kind of what caring
is to Democrats.
That freedom is
really at the core
of what makes people
in that party tick.
And there's some really
good things about freedom.
And, you know, I kind of got an
appreciation for Republicans,
and conservatives
for that matter,
in the course of doing that.
You can't do that if you see
it in like-minded classrooms
all the time, if you're always
with like-minded people.
So you've got to go learn
about different people.
And it's not always
easy, because especially
here in Cambridge we live
in this rarefied atmosphere.
And it's hard to meet
southern truck drivers.
ROBERT BLENDON:
Someone want to get in?
Because I'm going to change
the subject in a second.
STUDENT: Hi, my name
is [? Daniel Odan ?].
I'm an MPH student here.
Just going off your
piece of career advice,
and getting involved in the
political process, how do you--
that process, to me, is
about being a generalist.
So being very
flexible, doing what
needs to be done in whatever
campaign your involved.
Whether you're a policy advisor,
whether your hammering lawn
signs in a neighborhood.
How do you balance
that with the advice
you gave on being
a subject expert?
And how do you decide
when to assert yourself
as a subject expert
inside of these campaigns?
ELAINE C. KAMARCK:
Well first of all,
campaigns are no place
for subject experts.
OK?
They don't exist.
Nobody cares.
OK?
Don't think that subject
experts matter in campaigns.
They don't.
It's all about the broad vision,
the broad generalization, et
cetera.
Where the subject experts matter
is in the government itself,
when you win.
And that's where I
mean it's important
that you understand where the
other side is coming from,
because your opponents there
are going to be powerful,
entrenched, interests,
interest groups, members
the opposite political
party, or as often happens
a faction within your own
party that's supposed to this.
I don't want to
say that campaigns
have a lot of place
for expertise.
They don't, unless
your expertise
is in stratified random
sampling and polling.
Then you're--
ROBERT BLENDON:
That's very important.
ELAINE C. KAMARCK: Then
Mr. Blendon's skill set
is the very valuable skill set.
But it's in government
where people with expertise,
like yourselves, find
themselves in government.
And that's when they need
to be able to understand
the political context
in which they exist,
what the opposition is about,
who the opposition is, what
the factions are within
their own political party.
In the book that
Professor Blendon was
so kind to mention I talk about
the 2007 immigration bill,
where you would have thought
that a newly elected president
and a Republican who wanted
immigration reform ever
since he was governor of
Texas, and a new Democratic
Congress led by Nancy
Pelosi-- first woman speaker,
highly popular at the time, and
for immigration reform-- Hey,
you would have thought
they could do it.
Right?
Both houses of the Congress
wanted it, President wanted it.
It was a big flop.
They pulled it off
the Senate floor.
They didn't even let it get to
a vote it was such a big flop.
Now, one of things I
talk about in the book
is unpacking what
happened there.
And both sides misunderstood
their political parties.
So George Bush
did not see coming
into the nativist element
in his own party that
was very much opposed
to immigration reform.
He just didn't see it coming.
Or he thought that with
enough democratic votes
he could roll over them.
Nancy Pelosi did not see the
complete apathy of the Black
Caucus towards
immigration reform.
Total apathy.
Karl Rove interestingly
enough in his biography talks
about having President Bush
go to the Democratic Caucus
Retreat somewhere
in West Virginia.
And President's speaking
about immigration reform,
and everybody's going,
yeah, yeah, yeah.
And Karl Rove is standing
at the back at the table
where the members of the
Black Caucus are sitting.
Everybody applauding.
Not that table.
And Karl Rove goes, oh my god.
That's when he realizes they've
got a problem, because there
wasn't a united
Republican Party.
Nor was there a united
Democratic Party.
So once you get to a place where
you're trying to do something,
then understanding a
broader political context,
understanding something
about parties,
something about
the way the system
works, something about interest
groups, then it matters a lot.
And it's a combination
of the two.
I used to tell my students, all
these students at the Kennedy
School, Condoleezza Rice is
a very wonderful academic.
Right?
But there are probably
1,000 equally wonderful
foreign policy academics
as Condoleezza Rice.
What did she have?
She understood George Bush.
She understood the political
party in which she lived.
And so she became a very,
very valuable aid to him
through the eight years, and
one of the most powerful women
in America.
But her foreign policy
expertise was only
the beginning of the expertise.
ROBERT BLENDON: Are
we shaking our heads?
Let me just move
it slightly over.
A lot of students
from around Harvard
end up working for
Cabinet Secretaries
in some junior role.
And they will arrive with a view
about what makes an effective
Cabinet Secretary
and what doesn't.
You've had a chance to look
at a lot of these players.
Yes.
What makes an effective
Cabinet Secretary in your mind,
particularly from a
president's point of view?
ELAINE C. KAMARCK: From
presidents' point of view
it's two things, and there's
nothing else frankly.
It is, first of all, does
the Cabinet Secretary
get my priorities
and my campaigns?
OK?
Are they for
reinventing government?
Are they for this health
care plan, et cetera?
But the second is, can this
Secretary manage this big thing
underneath them so that
it doesn't screw me up.
That's all.
Don't screw me up.
That's what they want.
Don't have a Katrina
when I'm president.
Don't have the health
care bill come out
and then fall to pieces in the
first month of its operations.
They want to be on
the same wavelength,
and they want no trouble.
And they want you
to be successful,
which mostly means
you manage this thing,
and you keep the crises quiet.
Or you anticipate
crises and you make
sure that they don't blow up.
ROBERT BLENDON: So
in your experience,
what is the best
background, or does it just
depend on the individual
about who does this very well?
ELAINE C. KAMARCK: As
Cabinet Secretaries?
ROBERT BLENDON: Yeah.
ELAINE C. KAMARCK: It's
usually a former governor.
I mean, it's usually.
Now there's some
notable exceptions.
But it's usually
a former governor
because governors
have the experience
in managing large organizations.
They are very much
accountable for action.
Or big city mayors too.
Same difference.
And they're accustomed to
working in a political context,
and with a
legislature, et cetera.
So it's usually somebody who's
had that kind of experience.
Rarely do subject
matter experts work.
But sometimes they do.
Bob Reich, Harvard's
own Bob Reich,
was a very good Labor Secretary.
Part of it is, he had
a close relationship
with the President.
So he had some
White House access
that not every
Cabinet Secretary had.
But he also took to
the managerial task.
He got Tom Glenn who some of
us know to be his number two.
And Tom had actual
managerial experience.
So as long as you get
it in there some way
and understand that you need
it you can be pretty good.
But it's generally governors who
come with the right skill set.
ROBERT BLENDON:
So before I switch
in a minute to applying
this to the ACA,
you have a chance for
one more question.
I can't let the ACA go by,
not only because there's
a governor involved, but
because for a lot of us
they're something we watch.
Somebody else want to get in?
So what are the lessons--
ELAINE C. KAMARCK: I think you--
ROBERT BLENDON: We're going to
go to lessons from reinventing
government, for running the ACA
and getting it off the ground.
STUDENT: Hi, my name is Michael.
I'm a Master student in
Health Policy and Management.
I used to live in Washington.
And something that turned me
off of the political process,
and a lot of my peers, was
the sort of existential terms
in which the discourse
seems to be playing out now.
And I don't know how knew
that is to American politics.
I was born in the '80s, so you
can probably shed some light
on what things were
like before then.
But I'm wondering whether you
saw any effective strategies
while you were in
government to temper down
the nature of the debates, and
encourage people, especially
in eras of mixed government,
which you served in
as we are in now,
encourage people
to have more reasoned discourse,
in the media, or on the hill,
or wherever it might
be playing out.
ELAINE C. KAMARCK: Well first
of all, it's not at all new.
Newt Gingrich and
his friends regularly
thought Bill and Hillary
Clinton were murderers.
They thought that they
murdered Vince Foster.
So this is not is
not exactly new.
It's always been
[INTERPOSING VOICES]
ROBERT BLENDON: Lawyer
associated with the Clinton's
for those of you
[INTERPOSING VOICES]
ELAINE C. KAMARCK: Yeah.
And he committed suicide.
And there were people
who for four years
thought that they'd killed him.
This is really ugly.
You want an ugly race?
Go back to 1800.
Look at Thomas Jefferson's
race against John Quincy Adams.
That was ugly.
You had pamphleteers
in those days.
They printed anything
they wanted to.
There were no libel laws
that were at all prosecuted.
It was awful.
It was ugly.
Ugly.
How about the
presidential race of 1860?
Not only was it ugly, with
a lot of name calling,
we then proceeded to kill
each other for four years.
Now that's an ugly race.
So the first thing I'd say to
your generation is, toughen up.
Toughen up.
This is hard work.
People have real beliefs.
And they were real
things at stake.
And name calling is the
least of the problems.
Now there is an issue
that is fairly new.
And the issue
that's fairly new is
that there's an informal
quality to Washington that
used to exist right up until
recent years, where the name
calling was kind of for
show, and then people
would kind of drink together
and they'd figure out
what they were
actually going to do.
As Congress started to
be a part time job, where
they arrive on Tuesday morning
and they leave as soon as they
can on Thursday afternoon
to go back to their district
and raise money, the time
for informality has shrunk.
So people who used to call
each other names during the day
and then have drinks
together at night, now
just call each other
names during the day.
And so there's a lot
of discussion about,
how do you bring that back?
How do you bring
back the space that
used to be for negotiation?
And there's a lot
of things in here.
Congress used to be,
still is, mostly men.
But successful political
wives were always
women who loved politics as
much as their husbands did.
And so there was a whole
world of Washington hostesses.
And they gave parties.
They gave dinner parties.
And the good
Washington hostesses
were really good at putting the
two enemies next to each other
and facilitating the
conversation that
made them work.
And so now that era's gone.
Women aren't going to
start giving parties again,
because the women work.
But the question is,
how do you get back
to the functional
equivalent of that space
where people could actually
know each other, stop calling
each other names?
And you worked on
one thing, and then
you see that you could maybe
work on the next thing,
and you can work
on the next thing.
So that's really
what the problem is.
It's not the name calling,
which we've always had.
It's the absence of
informality, and a way
to make the system work.
And so you're going to
find political scientists
saying some pretty
strange things lately.
Like, bring back earmarks, those
bad, awful things earmarks.
Earmarks were what let
somebody vote for something
to make a majority, even
if they didn't like it.
ROBERT BLENDON: It's
allowing you to get something
for your own district.
ELAINE C. KAMARCK: Yeah.
You got something for
your own district.
You got a bridge,
you got a school,
you got a rock and
roll history museum.
Whatever it was.
You got something that
allowed you to give that vote.
And there's a lot of discussion
now among political scientists
about, how do we
recreate a system that
allowed for the informality
that, in the end,
made the system work, and didn't
result in government shutdowns,
and almost defaulting
on the US debt?
Which was unheard in
prior generations.
So I think that's
where the problem is.
And name calling--
get used to it.
ROBERT BLENDON: All right.
I'm going to forget
name calling.
We're going to the ACA.
What are the
lessons learned here
from years of watching how
government functions, or not,
about how this plays out in the
future, but also how it might
have played out differently?
ELAINE C. KAMARCK:
OK, so let's start
with information technology.
As I told the
smaller group before,
the month that ACA
was falling apart we
had two American
astronauts floating
in space outside of
the space shuttle
making repairs to
the space shuttle.
Their space suits
were made by a company
called Ocean Engineering.
And the technology that
allowed them to do the space
walks-- made by a
company over here
in Wooster, the
David Clark Company.
Space shuttle is made by
Boeing is the prime contractor,
and an infinite number
of smaller contractors.
And it was all put together by
US government civil servants
working at NASA.
GS-14s, 15s, 16s, and SES.
There is nothing inherent
in the US government
that says we can't
do technology.
Because we do pretty
awesome technology.
Even though a lot of people
have moral opposition
to this, which I take seriously,
the fact of the matter
is that we can pinpoint
at a suspected Al Qaeda
terrorist halfway
around the world,
send an airplane that
has no person flying it,
and take out that person's car.
How did that happen?
Contractors run by US
government, civilian,
and military personnel.
Let's go to the ACA.
The set up.
Many, many contractors run by US
civilian government personnel.
So you have to ask
yourself, wait a minute,
there's nothing intrinsic
about this operation.
It happens all the time
in the US government.
What went wrong here?
So let's then look at that.
First of all, there's
no lead contractor.
There was no systems integrator.
There was nobody pulling
the whole thing together.
ROBERT BLENDON: Now who
makes that decision?
ELAINE C. KAMARCK:
That decision should
have been made by the Secretary
of Health and Human Services.
But the White House
should have known
to ask, who's the
lead integrator?
The space shuttle, it's Boeing.
Boeing has a responsibility that
all the parts and everybody's
working OK.
So that's problem number one.
Problem number two was they
did not recruit someone
in the White House who had
technological skills as opposed
to health policy skills.
So the people in charge of
this were health policy,
which is a fundamentally
different than building
mammoth IT systems.
Because of that,
they continually
made changes to what was going
to go on in the contracts.
And what the websites
needed to offer,
and what the interoperability
was, et cetera.
And as you know, change orders--
even if maybe some of you
maybe not here, but you've
probably built a house
or renovated house-- change
orders are a disaster.
They're a lot of money.
But they also start
adding complexity to it.
They also never rehearsed.
They didn't rehearse
this in the summer.
Last summer when
Sheila Burke and I
were starting to work on health
care, we kept asking people,
isn't there a test?
Isn't there a test?
They didn't run a test.
You've got to do tests.
Now the absence of
rehearsal is key to a lot
of other government screw ups.
You guys don't remember,
but in 1980 there
was a US military
endeavor to try and rescue
the Iranian hostages.
And the helicopters
crashed in the desert.
US servicemen were killed.
It was a major embarrassment
for Jimmy Carter.
Definitely cost
him the election.
And we didn't get our hostages
back for another year almost.
And what was the problem?
They never rehearsed it.
They never rehearsed
the operation.
So the rehearsing it to show
you where the bugs were,
they should have
doing it all year.
They should have been doing
it in a part of Vermont,
in a part of Nebraska.
They should have been
rolling this out in pieces,
and then fixing it, et cetera.
And they didn't.
Now I'm somewhat
sympathetic to that
because, given
the hostility they
were facing from
the Republicans,
clearly the rehearsals
would have shown problems.
The problems would
have been in the press,
they would have
been under attack.
But an experienced manager would
have understood that, better
to have little slings and
arrows from the rehearsal
then the big sling
and arrow when
the whole thing didn't work.
So that was also a problem.
This is basically a
management failure.
This is basically a
management failure.
And it shouldn't have happened.
It didn't really need to happen.
Finally, there's a problem
with the whole bill itself.
But I think that goes
beyond the question of,
what happened in the roll-out?
But basically this was
a management failure.
Don't let anybody
tell you that we
need to redo the entire
procurement system of the US
government.
Don't let anybody tell you
that civil servants don't
have the technological skills
to oversee contractors.
This happens all the
time in the US gov
in incredibly sophisticated,
detailed operations.
And it happens most of
the time successfully.
ROBERT BLENDON: So is it
that the White House doesn't
have a group that worries
about these types of issues?
Not mentioning the
Cabinet Secretary,
but she happened
to be a governor.
She happened to run
things in that state.
You would've thought.
ELAINE C. KAMARCK: You
would have thought.
But this White House has a
problem with implementation.
And it's not just here.
It's in everything from Syria.
The first place you saw it was
in the reaction to the BP oil
spill where it took three weeks
to discover the Coast Guard.
Literally it took three weeks.
I was waiting.
What about the Coast Guard guys?
What about the Coast Guard?
Sending messages in,
writing little op-eds.
What about the Coast Guard?
Coast Guard.
How about the United
States Navy sitting there?
Took them three weeks.
So there's a problem
with implementation.
I think it starts at the top.
It's just a lack of
management experience.
It's a lack of implementing big,
big, big processes like this.
And I wrote after the
ACA roll-out, I said,
this White House
needs a James Baker.
They need a Democratic
James Baker.
Somebody who is experienced
in all the moving pieces
of the government, and knows how
to put the technical expertise,
and put it together.
And I like to think I had
something to do with it,
a week later they brought John
Podesta back into the White
House to try to do exactly
that, make sure they do.
But there's a big implementation
problem in this White House.
It has not been solved.
It wasn't solved
in the first term,
even though we saw
in the first term.
It continues to be there.
You saw with the
screw ups in Syria,
and a whole thing that
didn't need to happen.
Now we've got a failed
Syrian peace process.
Those bad weapons are
still sitting in Syria.
They have not been moved.
So there's an
implementation problem.
And presidents sometimes get
this, and sometimes don't.
They all have their
implementation problems.
Jimmy Carter had the
hostages in the desert.
George Bush had Katrina.
The problem is that when you
fail in a big way like this,
you go down in the
public's estimation,
and you can get back.
Jimmy Carter never recovered
from those helicopters
crashing in the desert.
He went on to lose rather
spectacularly to Ronald Reagan.
George Bush was in
his second term.
But if you look at
his approval ratings,
they go down starting
in September of 2006,
and they just stay down.
They never rebound.
And so far the same thing has
happened to Obama's approval
ratings.
The lowest in his presidency.
They're in the 40s.
And the problem is, because
these tend to be sticky and not
move back, then what happens,
even after you fix the health
care system, and the
websites are up and working,
and people are signing
up, et cetera, you
don't have the political
clout to do anything else.
So you end up being a sort of
lame duck before your time.
So these implementation
failures historically
have been pretty
severe for presidents.
And yet presidents come
into office thinking
that it's their
rhetorical gifts,
they're messaging that matter.
ROBERT BLENDON:
Messaging is my thing.
My view is, any problem could
be solved by a better message.
Obviously not here.
How about some insights
about not the implementation,
but the process of
getting this bill
passed, and lessons learned.
One of the debates
about health reform
is, most people in
the audience will
live through two or three
more in their careers.
This doesn't end.
They continue.
Other things.
What are lessons
that you think we
may have learned
for the next round?
ELAINE C. KAMARCK:
Well the first lesson
that they over-learned was
the Hillary Care lesson.
We were simultaneous
in the White House
with Hillary's
health care process.
She had hundreds of
people working for her,
as did I. We were
told specifically
to stay away from health care.
So we didn't do any
process re-engineering
of Medicare, Medicaid,
anything like that,
because Hillary was going
to change everything.
So there's no reason
for us to do it.
So we kind of stayed away from
that piece of the government.
And what her health care process
did-- and you've probably
read the great
David Broder book,
it's a huge tome like this.
[INTERPOSING VOICES]
ROBERT BLENDON: Some
of you in the audience
are currently reading--
ELAINE C. KAMARCK: Some of you
are probably currently plowing
through it at your insistence.
Yes?
Well one of the things
that comes out in that book
is how they tried
to fix everything.
They tried to articulate
this down to the minutia.
And Congress had
no part in this.
So Obama administration
comes along,
and they do the exact opposite.
They go 180 degrees in
the other direction.
They let Congress do it.
Well the problem
with letting Congress
do everything is
there's 435 of them.
Or 535 when you
include the Senate.
And you are likely to get a
bill that has no coherence.
And at no point
did the White House
step in and draw a firm line.
So probably the biggest
failure was the absence
of a public sector alternative,
a public sector health
alternative to the
private sector, which
would have served as a check on
premiums and things like that.
But it happened at various
times where the White House just
stood back, much to the
mystification of people like me
who were like, what
are they doing?
What are they thinking just
kind of giving up here?
And so they kind of went in
completely the other direction.
And so you have a lot of things
in this bill that don't work.
And there's an architectural
problem with the bill.
I told a group
earlier, at Brookings
we are in the process
of monitoring the 2014
congressional primaries.
And we're looking
for two things.
Among the Republicans
were looking for
any sliver of light.
What kind of things might
they approve of going forward?
Among the Democrats
we're looking at,
what are the reform ideas?
What are the changes?
Because what we now know is that
even the Democrats are having
to go out there, and
they're having to say not,
we support Obamacare.
They're having to say,
we support health care.
And here's what I
would do to change it.
So I don't know-- we've only
been through the Texas primary
so far.
And we've got a whole
bunch more to go.
Stay tuned.
By October, hopefully we
will have two papers done.
One on the internal conversation
of the Republican Party.
One of the internal conversation
of the Democratic Party.
And I think that's
going to show us
where the ground is as we move
beyond the Obama presidency.
And then we'll start to
have a real conversation
about fixing this.
ROBERT BLENDON: Other questions?
All right.
Thinking ahead, just
assume-- I'm just
imagining this-- there
was a candidate called
Hillary Clinton.
ELAINE C. KAMARCK: Imagine.
ROBERT BLENDON:
And she was forced
to talk about health care again.
How do you think she's
going to approach this?
Because she has the
bill of her party,
she has the years of
experience, but there's
likely to be a lot of
problems lying on that table
when she's running.
ELAINE C. KAMARCK:
Well the big issue,
and the big political issue is
turning out to be the mandate.
And I would not be surprised if,
in fact, in the next two years
and we see the IRS
penalties disappear
for not signing up
for health care.
And then the question
becomes, are we
in a death spiral or not?
Do we get enough people
signing up without a mandate,
or with reduced penalties?
As it is-- and not
many people know this--
as it is, if you don't pay the
penalty for not having health
care, almost nothing
happens to you.
There's no lien against-- If
you don't pay your income taxes
they put a lien
against your property.
That's a big deal.
That serious.
If you don't pay the penalty
for not having health care,
they can't put a lien
against your property.
So the IRS has
already signaled, well
we consider this health
care thing less important
than the overall question of
paying the rest of your taxes.
And so I would imagine
that, if this goes away,
the question is then, what
does it do to sign up rates?
If, in fact, you just have
sicker people, older people
signing up, what does
that due to premiums?
Does that start a death spiral?
And by the time Hillary Clinton
is running, what does she say?
How does she do this if, in
fact, it's looking really bad?
So I think right now
she's be very quiet.
Most Democrats are being
pretty quiet about this.
But as we move
past these midterms
there's going to be a
big debate about this.
Because we'll also see
if the thing manages
to work itself out or not.
ROBERT BLENDON: All right.
We are going to
thank our speaker.
But a point I want to make
is the incredible importance
of people who move
in the public service
back to universities,
back to expertise.
And I do have a bias.
Getting involved in
politics is a way
of solving many of the
problems that people here
care about very passionately.
And though it can be tough--
Elaine emphasizes that this can
be a tough game-- it
is the kind of thing
that lead the changes that
people here care a lot about.
So I'm going to
thank Elaine again.
And I promised her we would
report on the number of you who
go into public
service after this.
And I want a card from the
White House when you're there.
Elaine, thank you very much.
ELAINE C. KAMARCK:
Thank you very much.
