The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
We focus on a number of topic areas identified by state health policy leaders as important to population health.
The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
Keep up with news and updates from the Milbank Memorial Fund. Get the latest from thought leaders, including Christopher F. Koller, president of the Fund.
We publish The Milbank Quarterly, as well as reports and issues briefs on topics important to population health.
Blog: The View from Here
Sep 26, 2017 | Christopher F. Koller, President
Sandy Praeger did not seek to be a leader. “Local party officials had to keep asking me,” she said of her first public position as a member of the Lawrence City Council. “The same thing happened when I was asked to run for the Kansas House of Representatives—I thought I was done.” But now public service was in her blood, and she went on to serve as chair of several committees in the Kansas Senate and was then elected three times as the state’s insurance commissioner.
Praeger identified that willingness to answer the call—to say “yes” when others see your potential and ask you to serve—as one of the lessons she has learned about public leadership. She was speaking earlier this month at the inaugural meeting of the second class of the Milbank Memorial Fund’s Emerging Leaders Program (ELP), a program designed to bring together individuals from the executive and legislative branches of state government to develop skills that enhance their effectiveness as leaders.
A former member of the Reforming States Group (RSG), which sponsors the ELP, Praeger was disarmingly straightforward in her advice to the group. She encouraged the attendees not to be afraid to reach across agencies, branches of government, and the political aisle to make progress. During her career in the Kansas House and Senate, Praeger built a reputation as a moderate Republican more interested in getting things done than in taking credit. Often this started with a commitment on her part to building a constructive relationship with people whose political positions were very different from hers—progressive Democrats and rock-ribbed Republicans. “If you work at it,” she said, “you can build connections with anybody.”
Relationships with people across government and the political spectrum are fine, but in work and politics there can be consequences to your own standing if you buck your leadership. Praeger was undaunted. “Do what you think is the right thing,” she said. “If you feel really strongly about something—if it is important to you—then stick with it. You will have to look yourself in the mirror every morning.”
She learned that lesson early in her career, taking an unpopular position on handgun control while on the City Council. That resulted in some slashed car tires, raucous public meetings, and a promise that her position would cost her the next election. “But I won by an even bigger margin the next time,” she noted with satisfaction.
This mix of pragmatism and conviction was recognized by her fellow state insurance commissioners who elected her chair of the National Association of Insurance Commissioners (NAIC). Praeger was the national spokesperson for the NAIC during the financial crisis of 2008, making the case for state-based insurance regulation and noting to Congressional committees that the federally regulated bank sector—not the state-regulated insurance companies—was the financial industry that was melting down. “Perhaps 50 sets of eyes are better than one,” she would tartly remind committee members.
When I got to know Praeger during this period, I was struck by another old-fashioned trait—her pleasantness. While she could preside over a meeting and drive a group to consensus, she was genuine and warm in her public and private interactions, treating her colleagues and staff with respect.
The group at the ELP meeting was impressed. The 19 attendees—legislators early in their careers and rising executive branch officials from Medicaid, human services, and public health agencies—had all been selected by RSG members for their potential to assume more responsibility in government in the coming years. After Praeger’s remarks—at dinner the first evening—a number of them clustered around her for additional questions. Several women stayed to speak to her, interested in her career path.
Over the next two days, ELP attendees had a series of sessions with national experts on topics such as managing change, successful negotiations, and using evidence in developing policies. In the coming year, they will meet virtually and in person. They have each been assigned a mentor who is a past or current RSG member to help them reflect on their work and what they are learning in the program.
In nominating this class, the RSG had chosen wisely. I was struck by the public spiritedness and engagement of attendees. “Every day, when my staff and I came to work,” said Praeger, reflecting on her time as insurance commissioner, “we knew we had a chance to help people.” That sense of service—and the purpose that comes from it—was palpable among ELP attendees.
While Praeger’s reflections were simple, they are not easily put into practice. Public service leadership is challenging—particularly in times of excess partisanship, insufficient funds, and low public opinion of government. There are easier and more lucrative ways to make a living. But civil society depends on committed leaders like Praeger and those in the ELP to say “yes” when asked to serve, to build relationships with people who think differently, and to do what they understand to be the right thing. We at the Fund are privileged to support them.
The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience.
Global Hospital Budgets in Maryland: When Economics and Altruism Align
June 14, 2018
Long Lives for All: Dumb Luck, Personal Virtue, or Public Policy?
May 31, 2018
Their Pain, Our Gain
April 30, 2018