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January 2002

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NEWS ANALYSIS

 

The new battleground

 

By Janice Gross Stein

 

Citizens are demanding more efficiency and accountability from the state. But efficient at what? Accountable to whom?

Throughout history, states, societies, and citizenship have been shaped by the way states have provided protection to their citizens against war. As citizens, we made a fundamental bargain: We empowered the state and charged it with the responsibility of providing protection from attack and collective destruction, and in return, we gave the state our loyalty and deference. In the past two months, as we have done many times before, we are turning back to the state to provide security from attack.

 

But are we again in the familiar relationship where we, as citizens, empower the state to provide security from attack and in return give it our unquestioning loyalty and deference? I suspect not.

 

It's unlikely that we will reinforce our traditional bargain with the state because, in the past few decades, we have begun to change the way we live our citizenship. We are part way through a long process of constructing a different picture of ourselves as citizens, and a different kind of relationship with the state. In this past year, I visited public schools, community clinics and hospitals to listen to the voice of citizens. I was not chiefly interested in health care and education, although they are very important to us as citizens, but rather in how we experience citizenship, not as an abstract idea, but in how we give it meaning, day in and day out. How do we live our citizenship in post-industrial society?

 

As I first began to listen, I heard talk of efficiency or cost-effectiveness everywhere in our discussion about public goods. Not only did I hear it, I lived it. My mother was hospitalized last year after she shattered her hip. Seven days after her surgery, a discharge co-ordinator caught me in the hospital corridor and asked what arrangements we had been able to make. I told her that my sister and I would need more time to find suitable accommodation where my mother would not have to climb stairs. The co-ordinator replied: "Your mother is now a negative statistic for this unit. Every additional day that she remains in hospital, she drives our efficiency ratings down."

 

Even as I raged about the conversion of a whole person to a negative number, I understood: Responding to a growing insistence on efficiency, her unit had been given seven days to discharge a geriatric patient after a fractured hip. If the patient remains on the floor for 10 days, the surgical unit becomes less efficient than the hospital and the government expect. In post-industrial society, efficiency has become an end, a value in its own right. Efficiency grows out of the competition that markets bring but what we are efficient at is discussed less and less, and sometimes not at all. When efficiency becomes an end instead of a means, it becomes a cult.

 

Of course, it is important to use efficient -- or cost-effective -- means to provide valued public goods so that public funds, which are never infinite and almost never adequate, can stretch to meet as effectively as possible the largest number of public needs. What distinguishes legitimate conversation from the ritual incantations of a cult is a serious discussion of purpose. But it's a complicated conversation: As soon as we begin to talk about purpose, our judgments are inevitably laced with political claims.

 

For example, to determine whether our schools are efficient at providing public education, whether they are cost effective, we have to understand the purposes of education. Effective at what? At producing literate students? At producing critical thinkers? At producing engaged young citizens? Would we want a system of public education where the majority of our high school students know nothing of Canadian history or values but excel at science and mathematics? What, in short, are the goals of education or health care in Canada? Without a discussion about the goals, and the values that inform these goals, we cannot even begin to talk about efficiency. Once we begin to talk about goals, it quickly becomes clear that efficiency is not politically neutral.

 

In the past 20 years, critics of the "inefficient" state have suggested new market-driven ways of providing public goods to citizens. These new experiments, including vouchers for public education and charter schools, medical savings accounts and public markets for health care, don't deliver what they promise. They have not yet provided clear gains in efficiency. But they are intensifying the demand for greater accountability in the delivery of our public goods.

 

As citizens, we badly want accountability from our public institutions. Whether we are talking about student achievement or medical error or patient satisfaction, we feel we have the right to know how public institutions are performing, whether they are effective. This is the voice of the citizen in post-industrial society.

 

As citizens change, so does the role of the state. It becomes contractor, regulator and partner. The state as contractor and regulator now has no choice when it enters into contracts but to specify, in advance and with some precision, exactly what kinds of services are expected and what kinds of standards must be met. Governments must now collect information not only about the costs of delivering public goods but also about their quality. The tragic results in Walkerton, Ont., and at airports in North America provide eloquent warning of the consequences of focusing largely on costs and failing to monitor quality and performance.

 

When the state was the sole deliverer of public goods, it had every incentive as a monopolist to conceal rather than reveal. The new post-industrial state needs transparency among providers, assurances of quality, and evaluations of the effectiveness of the public goods that are delivered. So do citizens.

 

However, as the state contracts out responsibilities for the delivery of public goods, many of our traditional institutions -- legislatures, committees -- lose their capacity to monitor, investigate and steer programs. The citizen becomes more important than ever.

 

Setting standards for those who deliver our public goods is difficult. The fundamental issues come alive in how we choose to count the dimensions of a problem. Yet, if we cannot devise standards for our local public school or the hospital down the street, how can we begin to think seriously about holding our more distant and impersonal governments accountable? And, if we cannot hold our public institutions accountable, how do we give meaning to our experience as citizens?

 

The critical question for citizens then becomes: Who sets the standards for our public institutions? Is accountability imposed by the state or negotiated through open, democratic processes? And, do we have the capacity to negotiate accountability? Much of the democratic debate of the next decade will turn on whether accountability is imposed or negotiated. It is the new battleground in the construction of democratic society.

 

[Professor Janice Gross Stein is the Director of the Munk Centre for International Studies at the University of Toronto, the Harrowston Professor of Conflict Management, and a Fellow of the Royal Society of Canada. This article was first published in the Globe and Mail, Toronto, Canada.  Adapted from The Massey Lectures 2001 --The Cult of Efficiency, published by House of Anansi Press; series to be broadcast on CBC Radio's Ideas. ]