Quick and Easy SolutionsAuthor(s): S. Donna Lind and Philip N. ReevesSource: Public Administration Review, Vol. 41, No. 6 (Nov. - Dec., 1981), pp. 713-714Published by: Wiley on behalf of the American Society for Public AdministrationStable URL: http://www.jstor.org/stable/975753 .

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COMMUNICATIONS 713

Professor Tummala shares a concern expressed in my ar- ticle on the state of performance appraisal. I cannot join him, however, in reaching a conclusion that the perfor- mance of the manager of NASA's space shuttle program did not merit a $10,000 award. Despite the delays and cost overruns, the shuttle worked-an unprecedented and extra- ordinarily complex managerial and technological feat. Perhaps a less than brilliant performance by the program manager and many others engaged in this remarkable endeavor would have us still on the launch pad counting even greater cost overruns. Maybe the manager should be faulted for poor planning and estimating in this pilot ef- fort, but absent persuasive facts and reasoning I am also reluctant to embrace this idea.

I regret that Professor Tummala's comments contain a number of inaccuracies which then serve as a basis for his assertions. To cite one example, he states: "Professor Rosen also contends that one-third of those he surveyed felt that the best available candidates were not selected to the SES. This is equally intriguing in the light of the Office of Personnel Management (OPM) claim that 98 percent of all those eligible actually joined the SES. Is there any empirical evidence to sustain Professor Rosen's argument, or is this idle speculation?" The pertinent paragraph in my article is as follows:

About one-third of the career executives that I contacted surfaced another problem that requires attention if SES is to achieve its primary objective of improving government operations. From their vantage points in almost every large agency, they indicated that some of those appointed as career executives in the past year (1980) were unlikely to perform as well as others who could have been appointed. In other words, the best available were not selected by responsible agency officials. The reasons cited most often were (1) political or personal favoritism and (2) pressure to meet affirmative action goals. For SES to make its full contribu- tion, it must have the best possible performers, and this means that the selection processes also require more effective guidance and monitoring by OPM.

Comment: The 98 percent of the career executives who joined SES did so prior to July 1979 without evaluation of qualifications (as provided by law) while my findings, cited above, related to the qualifications of individuals ap- pointed subsequent to that date.

Since some of Professor Tummala's other comments are either incorrect or only tangential to my article, interested readers may wish to take another look at it-in the March / April 1981 issue of PAR.

Bernard Rosen School of Government and Public Administration

The American University

Quick and Easy Solutions

To the Editor: We would like to submit this letter to the editor in re-

sponse to the article by Laura Volk, Jeanne B. Hutchins and Jean S. Doremus which appeared recently in PAR.

NOVEMBER/DECEMBER 1981

While we were pleased to see PAR include an article on long-term care, we were also shocked to read the content of "A National Cost-Containment Strategy for Long-Term Care," published in the September/October 1980 issue. At best the article is naive and misleading, at worst it presents a series of recommendations which if followed could signifi- cantly set back recent efforts to improve an admittedly problematic long-term care "non-system."

The background and premise presented are well consi- dered. There is no question that the cost of long-term care is approaching crisis proportions. The authors also offer a sound listing of political values which should underlie policy decisions regarding delivery of public services. It is not until the latter half of the article, focusing on interim strategies to alleviate long-term care problems, that the paper deteriorates to a listing of everybody's quick and easy (although some are not quick and many are not easy) over- simplified solutions to the problems of the health care system.

The topics introduced in the authors' recommended solu- tions are so broad that they would require a book to ad- dress fully. Our criticism could also fill a book but we will limit our comments to the most blatant flaws of the article. While it is implied that the ideas presented are new and creative, this is only true in part. Some of the recommen- dations are based on out of date information and some have been previously tried and found wanting. Further recommendations are based on facts which have not yet been fully verified.

One notable example of misleading information included in the article is the recommendation under Physician-Based Strategies to "support and promote a sizeable increase in number of students admitted to medical schools." Medical school enrollments are currently at an all-time high as a result of a strategy which has been vigorously pursued dur- ing this entire decade to the extent that there is a projected serious physician oversupply within the next few years.' It is widely recognized that since physicians are "the captains of the team," they "control the process of care and are largely responsible for the cost problem."' In other words, more doctors will not lower the cost of care. Thus, it would be difficult for any responsible policy maker to consider seriously a recommendation for further increasing the enrollment of medical schools as a cost-containment strategy.

This is one of several recommendations which are based on lack of information. The most serious flaw of the arti- cle, however, is total absence of discussion concerning the issue of aggregate costs of long-term care as compared to unit costs. It is implied that the cost of long-term care is a problem because the system encourages excessive and inap- propriate expenditures. While many of the incentives in the system have this effect, a primary cause of the explosion of long-term care costs is the demographic changes in our population.

No discussion of the problem of long-term care is com- plete without mention of the fact that there are more older persons in the country than ever before. From an elderly population of approximately 25 million comprising 11 per- cent of our total population in 1980, we will grow to over 50

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714 PUBLIC ADMINISTRATION REVIEW

million elderly constituting about 20 percent of our popula- tion in 2030.3 The most dramatically expanding group in the population is the "old-old," those over 75 years of age. The proportion of those 65 and over who are "old-old" was 37 percent in 1980 and is expected to be 45 percent by the year 2000.' It is this group in which the largest propor- tion of persons suffering from multiple chronic conditions and needing long-term care can be found. The impact of this trend on the need for services is exacerbated by other current social trends. For example, smaller, more mobile families and the prevalence of working wives severely limits the capacity of most families to support their older members in the functions of daily living. Even if the cost per long-term care bed were contained, the number of beds will continue to increase dramatically. Therefore, any cost- containment strategy must carefully examine the multi- faceted problems of the growing elderly population as a basis for policy recommendations.

There is no doubt that there are severe problems for which solutions are needed desperately. A naive, overly simplistic and totally undocumented proposal to revamp the entire system, however, does not recognize a growing body of research and several demonstration programs which have been undertaken in this area which are pointing us to new, counterintuitive approaches. The publication of these recommendations suggests the extent to which long- term care is outside of the mainstream of the field of public administration. This fact warrants serious examination given that the impact of an aging population will be felt in terms of demands placed on major public programs during the next 50 years.

S. Donna Lind, Ph.D. Assistant Professor

Philip N. Reeves, D.B.A. Professor and Chairman

Department of Health Services Administration George Washington University

Notes

1. U.S. Department of Health Education and Welfare. A Report to the President and Congress on the Status of Health Profes- sions Personnel, (Washington, D.C.: DHEW Publication No. (HRA) k79-93, 1978).

2. Fuchs, Victor R. Who Shall Live? (New York: Basic Books, 1974), p. 57.

3. U.S. Census Bureau, Current Population Reports. Series P-25, No. 311, 321, 519, 614 and 601.

4. Ibid.

Standing By Their Recommendations

To the Editor: Thank you for giving us the opportunity to respond to

the letter from Professors Lind and Reeves of George Washington University. Authors Volk, Doremus and Hut- chins stand by their recommendations, including the in-

crease in medical school enrollment to create more competi- tion in the long-term care field as a cost-containment measure.

The professors should have read the article more careful- ly and noted that our interim solutions were identified as "culled from the literature." Furthermore, Lind and Reeves should be informed that the proposal termed "naive" by them is being used as supportive material for long-term care legislation that is slated to come before the U.S. Congress in the 1981 session.

As a point of information, our paper was written as the initial part of a Public Management Simulation (PMS) sponsored by Assistant Professors Edward H. Downey and Robert Guhde at the State University of New York College at Brockport. Participants in the process included state and local practitioners as well as students from the Maxwell School at Syracuse University and the State University of New York at Albany. The original version of our paper (which did contain a section on demography) was written according to the time and length constraints defined by the PMS design, and served as a springboard for a summer research project. The culmination of this research was recently published in a policy study entitled, "Who Will Take Care of Me in 2020? A Speculative Look at Govern- ment-Funded Long Term Care."1I This study certainly goes into greater depth than our initial paper and might be of in- terest.

We wholeheartedly agree that the problems posed by the mounting cost of long-term care are in desperate need of solution and would be interested in learning about the "counterintuitive approaches" that Lind and Reeves allude to.

Laura B. Volk Rochester City School District

Jean S. Doremus Monroe County Department of Social Service

Jeanne B. Hutchins Councilwoman, Town of Brighton, N. Y.

Notes

1. Edward H. Downey and Robert Guhde (eds.), "Who Will Take Care of Me in 2020? A Speculative Look at Government- Funded Long Term Care" (Brockport, N.Y.: Public Admin- istration Program, 1980).

A Double-Negative

To the Editor:

Professor Lloyd Nigro's observations ("Attitudes of Fed- eral Employees Toward Performance Appraisal and Merit Pay: Implications for CSRA Implementation," Public Ad- ministration Review, January/February 1981) about the application of research on innovative processes to the im- plementation of the new federal merit pay and performance

NOVEMBER/DECEMBER 1981

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