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
Jan 29, 2018 | Christopher F. Koller, President
“Don’t steal. The government hates competition.” —Bumper sticker. While grousing about the burden of taxes and shoddy government services like the Department of Motor Vehicles is a popular—and often justified—pastime, a deeper and more serious antipathy to the role of government in our society has again come to the fore in recent years. Some attribute its roots to the Reagan Revolution (“Government is not the solution to our problem; government is the problem.”) and others to Newt Gingrich’s Contract with America in the 1990s. Regardless of the origins, Donald Trump rolled to the presidency on a wave of anti-government sentiment, with growing skepticism among many about the effectiveness and motives of anybody working in government.
One of the privileges of my job is associating with state health policymakers who take their public service seriously and work hard to serve the public good. These public officials don’t wrap themselves in self-righteousness and don’t call attention to themselves. They show up every day, try to make the right calls among a set of tough choices, and hope to get it right more often than not.
Four exemplary public servants left state service and the Steering Committee of the Fund’s Reforming States Group (RSG) this past year. The RSG is a bipartisan, voluntary group of state health policy leaders from both the executive and legislative branches who gather regularly to share information, develop professional networks, and work on solutions to pressing problems in health care. In this era of anti-government sentiment, I think it is worth calling attention to these departing colleagues—to remind us why people choose public service and what they can accomplish.
Linda Berglin served in the Minnesota Senate for 31 years, where she rose to chair the Senate Health and Human Services Committee. After her resignation in 2011, she worked for Hennepin Health, the Medicaid managed care organization of Hennepin County. Berglin is proud of her instrumental role in creating, amending, and preserving Minnesota Care, the Medicaid program for low- and moderate-income working Minnesotans.
In discussions with people who work on health care issues in Minnesota, Berglin’s name repeatedly comes up as the go-to health care person in the legislature in the 1990s and 2000s, the official who operated from a consistent set of principles and knew the issues and the details necessary for sensible, fair policies. “One thing I learned from her was the value of being in this work on health reform for the long haul and a willingness to be incremental,” said one of her colleagues in the executive branch. “Mind you, when the window was there, she took a shot down the field. But she was also okay with making policies incrementally better each year, knowing that if you do that for 20 years, by the end you have some pretty great policies.”
Terry Cline, a psychologist by training, could not decide if he liked federal or state service—so he did both. From 2001 to 2006, he served first as Commissioner of the Oklahoma Department of Mental Health and Substance Abuse Services and later as Secretary of Health. Then, until 2009, he worked in the federal government—first as administrator of the Substance Abuse and Mental Health Services Administration, then as an attaché for the Department of Health and Human Services in Iran. Oklahoma called again, and in 2009 he returned—first as Commissioner of Health and later adding the role of Secretary of Health and Human Services.
Terry’s understated demeanor has made him a natural in challenging positions, whether he was representing the US in Tehran or advocating for tobacco control and obesity reduction in Oklahoma City. When he spoke at RSG meetings, his colleagues always listened.
Sheila Peterson retired as North Dakota’s state budget officer this January, after 29 years in the office. North Dakota’s energy-based economy sees booms and busts, and managing the state’s two-year budgeting cycle requires both accuracy and discipline. Sheila was unflappable facing this challenge, describing revenue surpluses and shortfalls in the same calm manner. You knew, though, that her staff was prepared for them and that she would not bend a projection to fit a desired outcome.
Sheila’s peers elected her chair of the National Association of State Budget Officers several times, but what made her most proud was the respect of her colleagues. “I was honest, straightforward, knowledgeable, and non-political,” she told me. “Legislators trusted what I said. State agencies appreciated that I listened and was fair. My employees knew I always had their back.”
John O’ Bannon did not leave the Virginia House of Delegates by choice. A Republican who served since 2001, he was voted out this past November in an anti-Trump wave. “Hey, don’t cry for me,” the practicing neurologist said. “It was a wave election. I had a good run and I have a job to go back to.” Nonetheless, many in Virginia health care were disappointed. Officials in the administration of outgoing Democratic Governor Terry McAuliffe lamented that they had lost an intelligent and informed legislator who they could count on to ask good questions, give good advice, and treat them fairly. “John was extremely well-respected,” one said. “He always looked for a realistic way forward to improve care for patients.”
John loved RSG meetings and would advise newcomers to take ideas liberally from their peers. He practiced the same—working across the aisle with fellow legislators and the McAuliffe administration to introduce laws to allow for Narcan use by first responders and to establish an all-payer claims database in Virginia.
John was also not afraid of a good scrap, if the gains were worth it. “Oddly enough, I’m proud of an Attorney General’s opinion I requested on state budgeting,” he told me. “It clearly defined that government couldn’t just give to any nonprofit, but there had to be a nexus to essential services. [That request] almost got me kicked off the Appropriations Committee, but it did a lot to clean up our budgeting process—[we were] no longer doing earmarks.”
While, John, Terry, Sheila and Linda have left government work, they are not unique among public officials committed to serving the public good. These and other officials deserve gratitude, not disdain. In my own experiences, I have seen that while public service can bring out the worst in human nature—venality, excessive cautiousness, and bureaucratic indifference—it can also bring out the best—selflessness, courage, and, yes, even compassion.
A few years ago, after an evening of RSG discssion on health care provider mergers ran late in a hotel meeting room, I apologized to one of the wait staff who had to hang around while we finished. “Oh, I didn’t mind,” he said. “It was way more interesting than most meetings we have. And it was inspiring to hear public officials taking it all so seriously.”
Inspiration? From public officials? Indeed. Just look around.
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