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The Cult of Efficiency [Paperback]

Janice Gross Stein
5.0 out of 5 stars  See all reviews (1 customer review)
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Book Description

Aug. 1 2002 0887846785 978-0887846786 Revised
We live in an age dominated by the cult of efficiency. Efficiency in the raging debate about public goods is often used as a code word to advance political agendas. When it is used correctly, efficiency is important: it must always be part of the conversation when resources are scarce and citizens and governments have important choices to make among competing priorities. Even when the language of efficiency is used carefully, that language alone is not enough. Unilingualism will not do. We need to go beyond the cult of efficiency to talk about accountability. Much of the democratic debate of the next decade will turn on how accountability becomes part of our public conversation and whether it is imposed or negotiated. Janice Gross Stein draws on public education and universal health care, locally and globally, as flashpoints in the debate about their efficiency. She argues that what will define the quality of education from Ontario to India and the quality of health care from China to Alberta is whether citizens and governments can negotiate new standards of accountability. The cult of efficiency will not take us far enough.

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A timely and layered treatise on the idea of efficiency, the changing role of the state, accountability and choice. -- Globe and Mail

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4 of 4 people found the following review helpful
5.0 out of 5 stars The Cult of Efficiency Feb. 19 2006
By A Customer
This book should be mandatory reading for anyone who influences or develops public policy, especially as it pertains to health care and education. Gross-Stein competently and logically examines the differences between public goods and consumer goods and relates those differences to the current social arguments supporting public versus private approaches to delivering the values of public goods. She discusses how efficiency, in our modern lexicon, has become described as an end in itself instead of being a means to an end. One of the key questions she investigates whenever there is a stated goal of efficiency is, "efficient at what?" She speaks of how the language of efficiency is used to promote private interests and erode public interests. The book also covers the transparency and accountability dynamics of public vs. private enterprises. The book is easy to read and will hold the attention of anyone interested in 2 of the most fundamental social issues of Canadian society.
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1 of 1 people found the following review helpful
4.0 out of 5 stars Does Efficiency Make Good Policy? May 19 2012
By L. King - Published on Amazon.com
A nurse's remark on how delaying the discharge of her elderly mother from the hospital would negatively affect the unit's performance statistics led Professor Stein to a series of questions: Is efficiency desirable as a public good? Is efficiency actually a justification for other goals, and if so what are they? Do we have a common understanding of what efficiency means and can it be measured for social goods as it is for material production?

To some extent we get what choose to measure which is not necessarily what we either want or need. One trap that the health system can fall into is substituting throughput for efficiency focusing more on cost-containment rather than long term effectiveness. Stein also examines the case of school vouchers where the ostensible goal is to improve quality but the underlying ethos is equality. She finds that that where vouchers are equitably available for everyone (Cleveland, Chile, Ontario), the system favoured the privileged and added to inequality, whereas in Michigan vouchers were only offered to the poor, which achieved the desired goal. Costs weren't lowered but effectiveness was raised.

In practice a free market is rarely if ever efficient in terms of waste, yet it generates enough wealth to make up for it. In the case of government we have a single payer that contracts out to a number of private or public contractors, however price alone is not the sole benchmark. She notes that the utilitarian Jeremy Bentham introduced the notion of accountability. While we turn away from government to provide services we turn back to it to provide standards and monitor quality.

The final chapter looks at a new trend, that governments not only give us the citizen-consumer the liberty to choose, but the additional notion that they guarantee the availability of choice.

The book is organized into six chapters and was originally delivered on CBC radio and in a public forum in six parts for the annual Massey lectures in 2001. There is also short postscript chapter on the nature of Security in the Post Industrial Age, apropos of 9/11. Stein concludes that efficiency is more a means than an end, a process, not a value, a cultic shibboleth that that masks unstated goals. And perhaps it would be better if we say more precisely what we mean so that we achieve what we want.
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