Mildred and Katrina

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    • 00:00

      [MUSIC PLAYING][Mildred & Katrina: Two Versions of the Same Story]

    • 00:12

      DON KETTL: Hi.I'm Don Kettl.I'm Professor of Public Policy at the University of Maryland.I have a case study here today on Mildred and Katrina.And let me tell you first who each of these is.First Mildred.Mildred, as it turns out, is a story about my mother-in-law.And she was born in Texas, spent a good part of her time

    • 00:32

      DON KETTL [continued]: during her teens and 20s and 30s exploringTexas in the east part of the stateat a time when there was lots of adventure.She grew up picking cotton sometimes,and in fact when she was in her 20slearned how to fly a plane at a timewhen that was a pretty big adventureand when the basic instruments of the planehad to do with a compass and how much fuel that you had left

    • 00:53

      DON KETTL [continued]: and that was about it.At the time when World War II wasbeginning to come to an end, she met a returning flierfrom Europe.His name was Al and he was a guy from Connecticutwho had been a navigator Bombardier on B-17sduring World War II.Now this was a time when he was flyingwhen that was one of the most dangerous parts

    • 01:15

      DON KETTL [continued]: of any mission in Europe in that stage of the war.There was a special certificate that theygave fliers who managed to complete 25 missions in a B-17.It was a special certificate that said,you're now part of the lucky bastard club.And the odds, unfortunately, of beingable to earn that certificate were not very good.Only one in five flyers actually managed

    • 01:36

      DON KETTL [continued]: to be able to make it that far, through 25 missions.He actually completed 47, which was simplyincredible at the time when.The war was over, he went back, he was sent to Texasto try to shut down one of the air basesthat had been created during World War II,and there he met this young woman, mother, pilot whohad decided to settle there.

    • 01:58

      DON KETTL [continued]: She had lost her first husband a few yearsbefore the war and the two of them fell in loveand out of that relationship came my wifeand I was lucky enough to get to know them.In the last years of her life, Mildredwas just a wonderful person.Here you see her at her senior prom.They had a place where she was staying at that point

    • 02:19

      DON KETTL [continued]: where they decided to try to makelife great for the people who were residents at the facility.And the facility than she was in was a nursing homebecause she could no longer live on her own.She had a combination of issues that made it hardfor her to get around and so she livedin this wonderful facility where they took good care of herto the point of even having celebrations.And you can see a corsage on each arm

    • 02:40

      DON KETTL [continued]: to be able to celebrate her senior prom.[Mildred's Care]

    • 02:48

      DON KETTL: Well, the issues here hadto do with trying to find ways of trying to support herbecause the cost of being able to be maintainedin this facility, of being able just to pay the bills,was more than what her military pension that she had inheritedfrom her husband who had died a few years before would support,it was more than social security would pay.And it turned out that the way to do

    • 03:10

      DON KETTL [continued]: that was to pay her social security,pay for the amount of money that she had coming infrom the pension, turn that over to the nursing homewhere she was living.Medicare, the government's programto provide medical coverage for older Americans, coveredher health care and Medicaid cover the cost of the nursinghome, covered the cost of the day to day care for her bed

    • 03:32

      DON KETTL [continued]: and for her food and for her meals.[Mildred's Issues]

    • 03:39

      DON KETTL: Now, the interesting thing about this story,what I want to call the Mildred paradox,is that in the last two years of her life100% of her living expenses were paidfor by the federal government, 100% outof Social Security and the pensionand Medicare and Medicaid.100% of her living expenses paid for by the government.

    • 03:60

      DON KETTL [continued]: But in that course of time, she neverencountered a government employee.Now, how could that possibly happen?And the answer is that all the peoplewho provided the care for her-- the people whoworked for the nursing home, the people who provided healthcare when she needed a visit to the hospital,or regular care from doctors who visitedto take care of her-- all were paidfor government programs that were administered

    • 04:22

      DON KETTL [continued]: through proxies with the care delivered by nonprofit serviceproviders, people who worked for hospitals, none of whomwere government employees.So 100% of her care funded by the governmentwithout ever seeing a government employee.And the other piece of this is whatI want to call the military corollary, whereher care over the cost of her last years of life

    • 04:44

      DON KETTL [continued]: cost hundreds of thousands of dollarsfor some hospitalizations, for her basic care, food,shelter, for occasional visits to doctors,occasional ambulance visits when she needed to getto the hospital in a hurry.Hundreds of thousands of dollars of government expenditures,but nobody was in charge of determiningwhat the total amount of investment ought to be.

    • 05:07

      DON KETTL [continued]: A doctor would order a test and the governmentwould pay for it.She would go to a physician who would give her a physical,the government would pay for it.She had her room, her board, her meals,the government would pay for it.And there was nobody who was in chargeof putting all those expenses together and determiningthe total amount that the government ought to spend.So we had government paying for everything,

    • 05:29

      DON KETTL [continued]: but never encountered a government employee,government paying for everything and nobodyreally in charge of managing the overall cost of care.What we had was a very complex networkof different service providers-- nonprofit organizations,for profit companies, hospitals, nursing homes, nurses,ambulances, drug providers for prescriptions,

    • 05:51

      DON KETTL [continued]: and a whole collection of other things--all which provided her with a very good quality of lifein the last years that she lived but with no one being in chargeand with all of us as taxpayers paying for it.A stunning kind of collection that'sa real story and microcosm about the way in which somuch of the rest of government actually works these days.[About Hurricane Katrina]

    • 06:15

      DON KETTL: Now I want to go to Hurricane Katrina.And what I want to do before getting to that storyis to suggest before I get to the punch line at the endthat the story of Mildred and the story of Katrinaare in many ways the same story, believe it or not.The story about my mother-in-law and the government's responseto this massive storm turned out to be one and the same.

    • 06:35

      DON KETTL [continued]: You can look at your screen and seepictures of what it is that Hurricane Katrina didwhen it hit.The challenge was just simply stunning.Here was a storm that was forecast first to be a categoryfive major direct hit right on New Orleansand in the last second it turned away and everybody said, whew,we managed to escape.

    • 06:56

      DON KETTL [continued]: And actually I talked to someone who was thereon the ground in the aftermath and they really, trulythought that they might have dodged the bullet.The general that I spoke to was actually in Baton Rougeand he said he was on the phone and a soldier who was thereat one of the barracks inside New Orleanssaid, general, I think things arelooking pretty good-- no, wait a minute, general.

    • 07:16

      DON KETTL [continued]: Let me look out the window.General, there's water coming down the street.And so the general said, go back and check and seeif you can tell what's going on herebecause we thought we had dodged the bullet.General, there's more water coming down the streetand it's rising and it's rising fast.And at that point, they realized that the only place that watercould have come from was a breach

    • 07:36

      DON KETTL [continued]: in the levees that had been designed to protect the city.The storm which was supposed to havea direct hit on cit the city and then miss itturned out to have delivered a big clobberingblower around the back that breached the levees, thatcaused flooding, and that in a kindof sneak attack around the back ended up

    • 07:58

      DON KETTL [continued]: putting 80% of the city under water.What we saw at that point was unimaginable human tragedy.We saw people stuck on rooftops; wesaw people stuck in the Superdomeby the thousands unable to go anywhere else;we saw people trying to escape with no way out;we saw fields that were full of school buses that otherwise

    • 08:20

      DON KETTL [continued]: would have been able to drive people to safety but they wereunder water; we saw a police department that was essentiallydisabled because communications systems didn't work,the officers didn't have uniforms,they were running out of ammunition,they were running out of gasoline,they were having a hard time getting around;we saw CNN's Anderson Cooper walking down the streets askingin a plaintiff kind of way,

    • 08:42

      DON KETTL [continued]: why is it that government doesn'tseem to be able to respond?Why doesn't government get it?Why can't we try to find ways of tryingthat we know we know we want governmentto do because at that point the one thing it was clearthat government needed to do was to find a way to helpa city that had become drowned.How in the world could this possibly have happened?

    • 09:02

      DON KETTL [continued]: Well, President Bush, who in the early stages of the stormhad decided to leave most of the responseto state and local government officials,arrived at the scene a few days later,he put his arm around the administrator of the FederalEmergency Management Agency, Michael Brown,and said, Brownie, you're doing a heck of a job.

    • 09:24

      DON KETTL [continued]: But the one thing that was clear at that pointis that nobody was doing a heck of a job.The city was under water, people were stuck,there were people who were having a terrible time justgetting the basics of food and water, and shelter.It was clear that nobody was doing a heck of a job.How could this possibly have happenedto a major American city?

    • 09:46

      DON KETTL [continued]: How could we have failed in the ability to respond?And the answer was that it was an incredibly complicatedsituation of response.[Response to Katrina]

    • 10:02

      DON KETTL: Fema, the agency that Michael Brown headed,was a very small agency with limited resources.FEMA has a limited amount of abilityto be able to bring water and some basics,but FEMA's basic job is to try to get other people coordinatedto do the job and was struggling to try to do that.Other federal agencies were involved, but nobody among them

    • 10:23

      DON KETTL [continued]: was really in the lead.The state government had a prime responsibilityfor figuring out how to respond, but they were noton the front lines.The local government in New Orleans was on the front linesbut had limited capacity.Nonprofit organizations, includingthe Red Cross and other organizations,tried to do what they could.But what we had here was a case where it turned out

    • 10:43

      DON KETTL [continued]: that none of them were able to gettheir collective act together to be able to respond so that whenPresident Bush came and put his arm around Brownie and said,you're doing a heck of a job, it was clearthat that was the one thing not happening.Because the coordinated response that was needed was somethingthe government couldn't manage to beable to do-- until, that is, Admiral Thad Allen was sent in.

    • 11:06

      DON KETTL [continued]: At that point, he was the Commandant of the Coast Guard.And he tells the story about sittingon the eastern shore of Maryland on a weekend with his wife,watching TV as everyone else in America was, saying,this is just a terrible set of circumstances.The president ought to send somebody down thereto try to solve the problem.

    • 11:27

      DON KETTL [continued]: And an hour later, the phone rang.It was the President.He said, Admiral Allen, I want to go down thereto solve the problem.And in fact, he ran for a plane, flew down there,and he was put in charge of tryingto do what it is that had not happened so far.It turns out that on his arrival things changed instantly.He tells another story where one of things he did first

    • 11:48

      DON KETTL [continued]: was to go to a large room where all of the emergency workerswere gathered and he said, I wantyou to know two things as you start your work.The first is I want you to treat every person that you encounteras if they were a member of your own family.I want you to know that that's how I want you to treat them.And second, if you get into any trouble for doing it,

    • 12:08

      DON KETTL [continued]: I've got your back.And that in a heartbeat changed the wayin which the entire system began to respond because it focusedpeople on the nature of the problem, focused peopleon bringing the resources to bear that needed to be doneto be able to solve those problems,and it provided reassurance that he was thereto provide political bureaucratic protection

    • 12:29

      DON KETTL [continued]: against any kind of complaint and criticismabout what they were doing.With those actions, the government's responsebegan to improve because those whowere involved focused on the problem,focused on who had the resources to help solve the problem,and began to focus on moving awayfrom bureaucratic boundaries that preventedand frustrated people from doing it

    • 12:50

      DON KETTL [continued]: to a kind of interrelated piece to make surethat things actually happened.Well, what happened at that pointwas that the frustrations that had built up for days and dayswith the government's problem respondingbegan to melt away because if there was a helicopter thatwas flying in, ferrying supplies back and forth,and a Coast Guard lieutenant would look down and say,

    • 13:11

      DON KETTL [continued]: there's somebody stuck on the rooftop, what'sthe correct answer to a problem like that when you have ordersto go back to the base when you have somebody who'sstuck needing government help?Time after time what happened was itwas the problem that ruled, it was the responsethat turned out to be effective and helicopter pilotsstopped to rescue people.Because as it turns out, if you'restuck on the rooftop looking for a government's help,

    • 13:32

      DON KETTL [continued]: there's only one correct answer and thatis to have government come and intervene in the situationto do what it can do to solve your problems.And time after time, that's what it isthat helped turn things around.[The Big Issues]

    • 13:50

      DON KETTL: What is it that the story of Mildredand the story of Katrina have in common?Really, they're two different versions of the same storybecause in Mildred's case, the quality of carethat she got was really outstanding.There were doctors and nurses there were social workersand pharmacists, there were people in hospitals and peoplewho drove ambulances, all who worked together

    • 14:10

      DON KETTL [continued]: in a coordinated fashion to make sure that Mildred got what sheneeded when she needed it, even to the pointthat they had things planned to try to make sure these she hadfun, including the chance to be able to go to a senior promwhen she was 90 years old to be able to celebrate lifeat that point.People who worked together in coordinated fashionfrom different places funded by government to make sure

    • 14:32

      DON KETTL [continued]: that what she needed was what got done.What happened in Katrina was really the same story.It was a collection of people, all of whomfocused on the problem, brought the resources to bear,put the bureaucratic boundaries aside, and understoodthat solving the problem was the only thing thatreally mattered.And when the solution to the problembecame paramount, instead of trying to figure out

    • 14:53

      DON KETTL [continued]: where the boundaries were, that'swhen solutions began to happen.The key to understanding the Mildred paradoxis understanding that we have interlockingsystems of service provision without anyone clearlybeing in charge.Just ask yourself, can you think of any problemthat matters that any one organization could

    • 15:13

      DON KETTL [continued]: control any longer?Is there anything that matters that any one organization cancontrol and manage?Think about that.My guess is that you can't come upwith anything that fits that.And since everything increasinglyrelies on coordination among related pieces of a servicesystem, it's making that coordination work that's first

    • 15:35

      DON KETTL [continued]: and how we do that is driven by a focus on the natureof the problem to be solved and driving performancethrough that system of coordination.And then we end up with the problemof trying to figure out how to solve the Mildredcorollary, which is a situation wherethere are multiple systems in which no one is in control.How do we deal with that problem, as well?

    • 15:56

      DON KETTL [continued]: And the answer is that we focus on leadershipto expand boundaries, to solve problems.Conclusion.

    • 16:07

      DON KETTL: If we make government more and moreless a system of here is my lane and I'mgoing to drive within that lane and not stray outside of it,if we have a system of government that really focuseson paying attention to the boundaries,we will fail because there's no problem thatfits within those boundaries any longer.If we make government, on the other hand, a system thatfocuses on solving those problems to drive coordination,

    • 16:30

      DON KETTL [continued]: there is the road to success and thatwas what solved the problems for Mildredand that's what solved the problems with Admiral Allenwith Katrina.If we focus on how to hold government accountable,it means that the performance of governmentin solving those problems is what matters, not followingthe rules, not following the procedures as that whichconstrains action but something that really focuses

    • 16:51

      DON KETTL [continued]: on getting results is the thing that matters.One of the things that people say sometimes is, you know,that's not rocket science.Well, what I want to suggest is this is rocket science.If you ask yourself how it is that rocket scientists launchrockets, there's somebody who's in chargeof the payload, somebody who's in chargeof the weather, somebody who's in charge of the first stage

    • 17:11

      DON KETTL [continued]: and somebody who's in charge of the second stage,somebody who monitors the way that the rockets themselveswork, somebody who's in charge of fuel,somebody who watches the weather,somebody who makes the surrounding area safe,they have people who sit in a special bunker whoare in charge of launching the rocket, and people who are downrange to be able to track it.Different people with different functional specialties

    • 17:32

      DON KETTL [continued]: who have different things that they focus on,all who work together in coordinated fashionbecause it's launching the rocket that really matters.So what I really want to suggest isthat not only are Mildred and Katrinathe same problems and not only dothey have the same solutions, but that it is rocket science.And if we ran government more like the way we launchedrockets, if we ran government more like it was rocket

    • 17:55

      DON KETTL [continued]: science with strong leaders who ensure coordinationand pursued the goal that everybody wants to achieve,we'd have a more successful government more often.Now so often, we think that, well, just governmentcan't work.But I'm here to tell you that it did workfor Mildred, who had the last two years of her lifepaid for by government programs and providing hera high quality of life as a result of that coordination

    • 18:17

      DON KETTL [continued]: that she got.It worked when Admiral Allen arrived in New Orleansto be able to deliver the kind of services that people wanted.It works with rocket scientists, who launch rockets the waythat rocket scientists work.And what all of these cases have in commonis a focus on strong leadership, a focuson performance with results that matter for citizens,

    • 18:38

      DON KETTL [continued]: and a government that's coordinatedto ensure that it works in the waythat we all want it to work.That's what performance means, that'swhat accountability means, and that'sthe reality of a government that works for the 21st century.So let me ask you a couple of questions.First, can you imagine any programthat matters that any one agency can control?

    • 18:59

      DON KETTL [continued]: I bet that you can't because I'veasked this question in front of a lot of audiencesand no one has been able to play stump the band on this one.And if it's true that no one agency could controlany organization, any problem that matters, thenwhat implications does that have for the way in which governmentought to work?My second question that I want to askyou is that if what we really need

    • 19:20

      DON KETTL [continued]: is a collection of rocket scientists and government,how can we create these rocket scientists?How can we get the leaders that weneed to lead on the problems to which we need solutions?[MUSIC PLAYING]

Mildred and Katrina

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Abstract

Professor Don Kettl compares the government's response to Hurricane Katrina with his mother-in-law's experience with having her living expenses paid for by the federal government. He stresses the need for government to coordinate actions under strong leaders and with a focus on problem solving, rather than rules and regulations.

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Mildred and Katrina

Professor Don Kettl compares the government's response to Hurricane Katrina with his mother-in-law's experience with having her living expenses paid for by the federal government. He stresses the need for government to coordinate actions under strong leaders and with a focus on problem solving, rather than rules and regulations.

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