Fair and balanced
Ennis sent me to this article on Mr. Sillen, whom a judge has put in charge of health care in the
Sillen, on how prison health care got so bad, 10:20:
“Inherent in the nature of government, of the state, and of this state, to create the surroundings, within which the horrid conditions of the prison system can exist. CDCR has a lot to answer for on its own, but let’s remember, it is only a state agency. Legislatures and governors, they’re the folks with the clout.”
I know your bogeyman is a faceless unaccountable bureaucrat implementing some personal agenda that the voters never chose, but that is not what went wrong for prison health care. The problem for prison health care is that the relevant state agency, the California Department of Corrections and Reform (CDCR), gave the people exactly what they wanted. Californian politicians have constituencies that tell them to be tough on crime; the people who are hurt and killed by horrendous prison health care are not constituents. Literally. Their vote is taken from them. This leaves a huge hole in our prison policies. Legislators and the governor translated that hole directly onto the state agency. The voters don't hold their elected officials accountable for providing decent prison health care; elected officials didn’t require it of CDCR. Agencies don't do what no one wants, even if prisoners die.
“In state service, last year, you could have been a Windshield Wiper Specialist II in the Department of General Services and this year, you’re a health care manager in a prison system. What is that all about?”
This happens, and it is a problem. It is because the state has made hiring civil servants serve multiple purposes. One purpose is to get qualified people to do the job. A second purpose is to provide social mobility to the citizens we hire, make their employment also train and lift them into new professional ranks1. This is not a ridiculous thing for a state to do; we seem to think state employment should be a direct means of social mobility. If it is worth it to us, then we have to accept that it may mean that not all civil servants come into their jobs ready for it.
Also, the civil service promoting system is elaborate and rigidly regimented, and designed to be scrupulously fair to every last person ever. It has multiple barriers against a classic problem, that of political nepotism, giving state jobs as a reward for political support. Those barriers also stand against favoritism for anything else, like tremendous competence. Competence IS rewarded, but not with the fluidity of a private system. Seniority may interfere with the elevation of competence, in the short run. It is not as dire as the haters among you think, but it is not a purely merit based system, either.
Sillen on wasted state efforts, 17:18:
“But the fact of the matter is, in stereotypical fashion, the potential solutions have been on the table for years in
, and have been ignored, ignored, ignored.  But the fact of the matter is, is that when I did that audit and brought in some experts to do another audit, they called me back and said we can do this for half the price because there are five audits from state agencies and some outside agencies on that very same pharmacy situation in the prisons that nobody did a thing about.” California
Here’s the part I love, and he says it several times:
“There’ve been some improvements. But I’m… you know, we’ve done a lot over the first year, but we haven’t really scratched the surface. This is a long haul. And, we have to populate with good people, we have to make good working conditions, we have to get adequate space and adequate transport, we have to get adequate custodial officers. Et cetera et cetera. So yeah, there have been some…
Some of the politically popular programs are quite problematic, especially in the women’s prisons, like the mother and baby programs. Conceptually, I’m all for it. But unless CDCR does that right, you’re going to be writing and reading about dead babies. It’s as clear as day to me.
Things get done for strange reasons, and some of them for very good reasons. But then, the wherewithal and the expertise and its resources have to follow the good intentions. And usually they don’t. That is not to say that there isn’t more than enough money in CDCR. There is more than enough money in CDCR. It just isn’t spent right.
“We have located various pockets of personnel… remember, organizations operate, we’re people, it’s not bricks and mortar, it’s people, and it’s good people, and we are training and we are hiring and we are populating CDCR medical with good people, who know health care.”
“Hiring we refuse to take over. Because there are 1500, or 1250, I think, or 1400, or something way up there, positions that Judge Carlton has ordered in the mental health system, but there’s no mechanism to hire them. You know, there’s a difference between having money and recruiting and then actually hiring. And, the resources have never been put into infrastructure, operational infrastructure, administrative infrastructure. Its one of the reasons why CDCR has this incredible vacancy of correctional officers and ten thousand backlog of applicants and they can’t get ‘em hired.
Mr. Sillen thinks what I think. Mr. Sillen is saying that the quality of the civil service is not fixed, that it depends on the people who make up the bureaucracy. He thinks that if you want good governance, you hire good people and you support your programs with expertise and resources. That you can design systems that allow them to meet their responsibilities, and if you don’t you are squandering the public’s money. He intends to make that happen. I will love watching him.
I have all sorts of thought on how to get a good civil service, one that gives a good return for the taxpayer’s money. But it is very late, and that deserves a post of its own.
1I have seen this work. At the feds, we’d have senior project managers who started in the mail room, literally learned on the job for decades. Honestly, the good ones were women hired in the sixties, when sexism started them profoundly undereducated and underemployed. They got a shot, and moved up to their level of competence. This is awesome. Less sexism and racism and greater educational opportunity would mean that there are no longer these pockets of people with a huge gap between potential and skills. That would mean less room for this policy to improve the state work force. The worst employees, by the way, were
2I keep meaning to tell you about this fascinating dissertation I’m reading on how research gets included in policy solutions, because there is a SURPRISE ENDING.