I think we have to remember we have good people in healthcare. We are all attracted to the healthcare profession out of a sense of compassion, to be part of something larger than themselves… We have good people in healthcare working in a bad system. We have good people that have inherited this crazy game of inflating prices for the purpose of offering secret insurance discounts selectively to different groups. That crazy game was never intended to get this exaggerated, where hospital prices are laughable and the hospital CEOs themselves can’t interpret these bills.
That was Marty Makary on the EconTalk podcast episode, “The Price we Pay.” Certainly the problems of the defense market and its methods of pricing are different than healthcare. But I think it is well established that both are cost disease sectors. I have to imagine that better institutional arrangements would increase productivity. If that were not true, then many people are wasting time talking about reform.
Therefore, we have a bad system. But it is filled with dedicated and well-intentioned people. The problem is people don’t have an understanding of the system when they start their careers. There is a reason for everything, they find out. It becomes the only thing they know. And so they adopt the system — though they would have taken more delight in their jobs in some other institutional arrangement.
Do you think the acquisition workforce is vibrant? Do people feel like they are contributing their full creativity?
Here’s another part:
What’s happening in this marketplace different from others is you have price gouging — taking advantage of people — at a time when they are vulnerable… Hospitals were built to be a safe haven for the sick and injured, not to price gouge them and engage in predatory billing when they come to us for help. That violates the public trust. We should be different, we should be better.
There is an analogy in defense as well. The “requirements” approach is a long, drawn out process where the government decides this is what I need and when I need it. Multiyear bureaucratic plans are set in motion. The government almost never has viable alternatives after full-scale development starts. Moreover, military strategy depends on the program success. Tell me this is not a vulnerable position? Yet it is a problem the Pentagon inflict on itself!
If defense decisions on new technologies were made incrementally, financing viable alternatives in R&D if not through operations (e.g., for software), then defense officials will not make themselves vulnerable. Always have an option to buy something else.
Do I think the acquisition workforce is vibrant?
Some anecdotes… When I was teaching the Intermediate Project Management course for AFIT, I would periodically encounter junior officers who were big thinkers with a passion for delivering capability who unfortunately were on their way out as they were tired of the constant frustration they felt trying to fight the bureaucracy. I wonder how many of the very people we want in the acquisition workforce are leaving because of the system?
There are pockets of aggressive forward-leaning acquisition professionals in organizations like the Rapid Capability Office and Big Safari; but they get to hand-pick their personnel and when people don’t fit, they don’t stay (either by self-identification and leaving or being shown the door).
And, as has been discussed before, there’s the ‘frozen middle’ that seems to stifle the vibrancy of the junior workforce as they try to bring innovative ideas to fruition.
I guess my response to the question would be that the workforce’s vibrancy is likely represented by the bell-shaped curve. However, I think with changes to the system, we could move the whole curve towards being more innovative and vibrant.
” I wonder how many of the very people we want in the acquisition workforce are leaving because of the system?”
Yes, I think there is tons of vibrancy in people, but on the margin the DoD weeds them (or their enthusiasm) out of the system more than other sectors, despite having such an important mission in high technology which I think is attractive.
Vibrancy is probably a bell curve, but I must have only worked in the middle. I have spent 18 years in acquisition and my younger colleagues only excite me. They’re smart, enthusiastic, and ambitious. I have yet to see any leave despite the obviously complex working environment. The challenge I see is keeping that enthusiasm over time. It can be really hard to cause change. If you spent 30 years fighting the system, you get tired and worn out…right when you have the most influence to lead change.
Yes, switching industries can be hard, and it seems like we’ve seen less job mobility going on recently compared to say the 1950s. There’s a lot of energy and creativity out there that isn’t being taken advantage of because they are expected to execute standing orders in a larger bureaucratic plan.