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Another empty promise: Can Trump really make the government more efficient?

Jennifer Selin, Arizona State University

President Trump promises to make government efficient − and he’ll run into the same roadblocks as Presidents Taft, Roosevelt, Roosevelt, Truman, Eisenhower, Carter, Reagan, Clinton and Bush, among others

As President Donald Trump issued a slew of executive orders and directives on his first day of his second administration, he explained his actions by saying, “It’s all about common sense.”

For over a century, presidents have pursued initiatives to improve the efficiency and effectiveness of government, couching those efforts in language similar to Trump’s.

Many of these, like Trump’s Department of Government Efficiency, which he appointed billionaire Elon Musk to run, have been designed to capitalize on the expertise of people outside of government. The idea often cited as inspiration for these efforts: The private sector knows how to be efficient and nimble and strives for excellence; government doesn’t.

But government, and government service, is about providing something that the private sector can’t. And outsiders often don’t think about the accountability requirements that the laws and Constitution of the United States impose on government workers and agencies.

Congress, though, can help address these problems and check inappropriate proposals. It can also stand in the way of reform.

Proposing reform is nothing new

Perhaps the most famous group to work with a president on improving government was President Franklin D. Roosevelt’s Committee on Administrative Management, established in 1936.

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That group, commonly referred to as the Brownlow Committee, noted that while critics predicted Roosevelt would bring “decay, destruction, and death of democracy,” the executive branch – and the president who sat atop it – was one of the “very greatest” contributions to modern democracy.

The committee argued that the president was unable to do his job because the executive branch was badly organized, federal employees lacked skills and character, and the budget process needed reform. So it proposed a series of changes designed to increase presidential power over government to enhance performance. Congress went along with some of these proposals, giving the president more staff and authority to reorganize the executive branch.

Since then, almost every president has put together similar recommendations. For example, Presidents Harry S. Truman and Dwight D. Eisenhower appointed former President Herbert Hoover to lead advisory commissions designed to recommend changes to the federal government. President Jimmy Carter launched a series of government improvement projects, and President George W. Bush even created scorecards to rank agencies according to their performance.

In his first term, Trump issued a mandate for reform to reorganize government for the 21st century.

This time around, Trump has taken executive actions to freeze government hiring, create a new entity to promote government efficiency, and give him the ability to fire high-ranking administrators who influence policy.

Most presidential proposals generally fail to come to fruition. But they often spark conversations in Congress and the media about executive power, the effectiveness of federal programs, and what government can do better.

Most presidents have tried the same thing

Historically, most presidents and their advisers – and indeed most scholars – have agreed that government bureaucracy is not designed in ways that promote efficiency. But that is intentional: Stanford political scientist Terry Moe has written that “American public bureaucracy is not designed to be effective. The bureaucracy arises out of politics, and its design reflects the interests, strategies, and compromises of those who exercise political power.”

A common presidential response to this practical reality is to propose government changes that make it look more like the private sector. In 1982, President Ronald Reagan brought together 161 corporate executives overseen by industrialist J. Peter Grace to make recommendations to eliminate government waste and inefficiency, based on their experiences leading successful corporations.

In 1993, President Bill Clinton authorized Vice President Al Gore to launch an effort to reinvent the federal government into one that worked better and cost less.

The Clinton administration created teams in every major federal agency, modeled after the private sector’s efficiency standards, to move government “From Red Tape to Results,” as the title of the administration’s plan said.

Presidential attempts to make government look and work more like people think the private sector works often include adjustments to the terms of federal employment to reward employees who excel at their jobs.

In 1905, for example, President Theodore Roosevelt established a Committee on Department Methods to examine how the federal government could recruit and retain highly qualified employees. One hundred years later, federal agencies still experienced challenges](https://www.gao.gov/assets/gao-03-2.pdf) related to hiring and retaining people who could effectively achieve agency missions.

So why haven’t these plans worked?

At least the past five presidents have faced problems in making long-term changes to government.

In part, this is because government reorganizations and operational reforms like those contemplated by Trump require Congress to make adjustments to the laws of the United States, or at least give the president and federal agencies the money required to invest in changes.

Consider, for example, presidential proposals to invest in new technologies, which are a large part of Trump and Musk’s plans to improve government efficiency. Since at least 1910, when President William Howard Taft established a Commission on Economy and Efficiency to address the “unnecessarily complicated and expensive” way the federal government handled and distributed government documents, presidents have recommended centralizing authority to mandate federal agencies’ use of new technologies to make government more efficient.

But transforming government through technology requires money, people and time. Presidential plans for government-wide change are contingent upon the degree to which federal agencies can successfully implement them.

To sidestep these problems, some presidents have proposed that the government work with the private sector. For example, Trump announced a joint venture with technology companies to invest in the government’s artificial intelligence infrastructure.

Yet as I have found in my previous research, government investment in new technology first requires an assessment of agencies’ current technological skills and the impact technology will have on agency functions, including those related to governmental transparency, accountability and constitutional due process. It’s not enough to go out and buy software that tech giants recommend agencies acquire.

The things that government agencies do, such as regulating the economy, promoting national security and protecting the environment, are incredibly complicated. It’s often hard to see their impact right away.

Recognizing this, Congress has designed a complex set of laws to prevent political interference with federal employees, who tend to look at problems long term. For example, as I have found in my work with Paul Verkuil, former chairman of the Administrative Conference of the United States, Congress intentionally writes laws that require certain government positions to be held by experts who can work in their jobs without worrying about politics.

Congress also writes the laws the federal employees administer, oversees federal programs and decides how much money to appropriate to those programs each year.

So by design, anything labeled a “presidential commission on modernizing/fixing/refocusing government” tells only part of the story and sets out an impossible task. The president can’t make it happen alone. Nor can Elon Musk.

Jennifer Selin, Associate Professor of Law, Arizona State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Backtracking the Biden-Trump debate, here's what they got wrong, and right

by Amy Maxmen
KFF Health News and PolitiFact

Trump campaigned on a promise to repeal and replace the Affordable Care Act, or ACA. In the White House, Trump supported a failed effort to do just that. He repeatedly said he would dismantle the health care law in campaign stops and social media posts throughout 2023.

President Joe Biden and former President Donald Trump, the presumptive Democratic and Republican presidential nominees, shared a debate stage June 27 for the first time since 2020, in a confrontation that — because of strict debate rules — managed to avoid the near-constant interruptions that marred their previous encounters.

Biden, who spoke in a raspy voice and often struggled to articulate his arguments, said at one point that his administration “finally beat Medicare.” Trump, meanwhile, repeated numerous falsehoods, including that Democrats want doctors to be able to abort babies after birth.

Illustration: Richard Duijnstee/Pixabay

Trump took credit for the Supreme Court’s 2022 decision that upended Roe v. Wade and returned abortion policy to states. “This is what everybody wanted,” he said, adding “it’s been a great thing.” Biden’s response: “It’s been a terrible thing.”

In one notable moment, Trump said he would not repeal FDA approval for medication abortion, used last year in nearly two-thirds of U.S. abortions. Some conservatives have targeted the FDA’s more than 20-year-old approval of the drug mifepristone to further restrict access to abortion nationwide.

“The Supreme Court just approved the abortion pill. And I agree with their decision to have done that, and I will not block it,” Trump said. The Supreme Court ruled this month that an alliance of anti-abortion medical groups and doctors lacked standing to challenge the FDA’s approval of the drug. The court’s ruling, however, did not amount to an approval of the drug.

CNN hosted the debate, which had no audience, at its Atlanta headquarters. CNN anchors Jake Tapper and Dana Bash moderated. The debate format allowed CNN to mute candidates’ microphones when it wasn’t their turn to speak.

Our PolitiFact partners fact-checked the debate in real time as Biden and Trump clashed on the economy, immigration, and abortion, and revisited discussion of their ages. Biden, 81, has become the oldest sitting U.S. president; if Trump defeats him, he would end his second term at age 82. You can read the full coverage here and excerpts detailing specific health-related claims follow:

Biden: “We brought down the price [of] prescription drug[s], which is a major issue for many people, to $15 for an insulin shot, as opposed to $400.”

Half True. Biden touted his efforts to reduce prescription drug costs by referring to the $35 monthly insulin price cap his administration put in place as part of the 2022 Inflation Reduction Act. But he initially flubbed the number during the debate, saying it was lowered to $15. In his closing statement, Biden corrected the amount to $35.

The price of insulin for Medicare enrollees, starting in 2023, dropped to $35 a month, not $15. Drug pricing experts told PolitiFact when it rated a similar claim that most Medicare enrollees were likely not paying a monthly average of $400 before the changes, although because costs vary depending on coverage phases and dosages, some might have paid that much in a given month.

Trump: “I’m the one that got the insulin down for the seniors.”

Mostly False. When he was president, Trump instituted the Part D Senior Savings Model, a program that capped insulin costs at $35 a month for some older Americans in participating drug plans.

But because it was voluntary, only 38% of all Medicare drug plans, including Medicare Advantage plans, participated in 2022, according to KFF. Trump’s plan also covered only one form of each dosage and insulin type.

Biden points to the Inflation Reduction Act’s mandatory $35 monthly insulin cap as a major achievement. This cap applies to all Medicare prescription plans and expanded to all covered insulin types and dosages. Although Trump’s model was a start, it did not have the sweeping reach that Biden’s mandatory cap achieved.

Biden: Trump “wants to get rid of the ACA again.”

Half True. In 2016, Trump campaigned on a promise to repeal and replace the Affordable Care Act, or ACA. In the White House, Trump supported a failed effort to do just that. He repeatedly said he would dismantle the health care law in campaign stops and social media posts throughout 2023. In March, however, Trump walked back this stance, writing on his Truth Social platform that he “isn’t running to terminate” the ACA but to make it “better” and “less expensive.” Trump hasn’t said how he would do this. He has often promised Obamacare replacement plans without ever producing one.

Trump: “The problem [Democrats] have is they’re radical, because they will take the life of a child in the eighth month, the ninth month, and even after birth.”

False. Willfully terminating a newborn’s life is infanticide and illegal in every U.S. state.

Most elected Democrats who have spoken publicly about this have said they support abortion under Roe v. Wade’s standard, which allowed access up to fetal viability — typically around 24 weeks of pregnancy, when the fetus can survive outside the womb. Many Democrats have also said they support abortions past this point if the treating physician deems it necessary.

Medical experts say situations resulting in fetal death in the third trimester are rare — fewer than 1% of abortions in the U.S. occur after 21 weeks — and typically involve fatal fetal anomalies or life-threatening emergencies affecting the pregnant person. For fetuses with very short life expectancies, doctors may induce labor and offer palliative care. Some families choose this option when facing diagnoses that limit their babies’ survival to minutes or days after delivery.

Some Republicans who have made claims similar to Trump’s point to Democratic support of the Women’s Health Protection Act of 2022, which would have prohibited many state government restrictions on access to abortion, citing the bill’s provisions that say providers and patients have the right to perform and receive abortion services without certain limitations or requirements that would impede access. Anti-abortion advocates say the bill, which failed in the Senate by a 49-51 vote, would have created a loophole that eliminated any limits on abortions later in pregnancy.

Alina Salganicoff, director of KFF’s Women’s Health Policy program, said the legislation would have allowed health providers to perform abortions without obstacles such as waiting periods, medically unnecessary tests and in-person visits, or other restrictions. The bill would have allowed an abortion after viability when, according to the bill, “in the good-faith medical judgment of the treating health care provider, continuation of the pregnancy would pose a risk to the pregnant patient’s life or health.”

Trump: “Social Security, he’s destroying it, because millions of people are pouring into our country, and they’re putting them onto Social Security. They’re putting them onto Medicare, Medicaid.”

False. It’s wrong to say that immigration will destroy Social Security. Social Security’s fiscal challenges stem from a shortage of workers compared with beneficiaries.

Immigration is far from a fiscal fix-all for Social Security’s challenges. But having more immigrants in the United States would likely increase the worker-to-beneficiary ratio, potentially for decades, thus extending the program’s solvency.

Most immigrants in the U.S. without legal permission are also ineligible for Social Security. However, people who entered the U.S. without authorization and were granted humanitarian parole — temporary permission to stay in the country — for more than one year are eligible for benefits from the program.

Immigrants lacking legal residency in the U.S. are generally ineligible to enroll in federally funded health care coverage such as Medicare and Medicaid. (Some states provide Medicaid coverage under state-funded programs regardless of immigration status. Immigrants are eligible for emergency Medicaid regardless of their legal status.)

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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When it comes to gerrymandering, Illinois flunks big time

by Mark Richardson
Illinois News Connection

CHICAGO - A national watchdog group studied how all 50 states handle the biennial process of redrawing their congressional district lines - and has given Illinois a failing grade.

Common Cause issued its report this week, analyzing how effective each state has been in drawing fair, independent and balanced district maps. Only two states - California and Massachusetts - earned an "A" while 17 states were in the "D" or "F" category.

Dan Vicuña, national redistricting director for Common Cause, said there was a consistent thread among the states that rated poorly.

"The states that rank near the bottom shared some things in common," he said, "which include a lack of transparency and an unwillingness to give the public much, or any, notice about when meetings would take place; having redistricting hearings for the public during traditional working hours."

The report said Illinois was a "nearly perfect model" for everything that can go wrong with redistricting. The state Legislature scheduled hearings in places and at times when many people could not attend. The report said the result was heavily gerrymandered in favor of Democrats, which drew lawsuits from a half-dozen civil-rights groups.

To improve the process, Vicuña said, Illinois needs to develop a nonpartisan system or commission with broad representation to draw up districts, hold well-advertised hearings in public places after work hours, increase language assistance and improve access for people with disabilities.

"States that find a different path and take that power away and create citizen commissions, create bipartisan, multi-partisan processes for drawing districts - keeping political insiders boxed out of the process, and making redistricting community-centered - has resulted in great success," he said.

Vicuña said Illinois lawmakers drew congressional and state legislative districts through the legislative process, using it in this cycle to protect a Democratic supermajority. Reformers have twice put ballot initiatives in front of voters to create independent, citizen redistricting commissions in the last decade, winning both times. However, both laws were subsequently struck down by the IllWhinois Supreme Court.

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