Tuesday, July 24, 2007


AB 1427 is a bill, now in suspense (whatever that means) with provenance that may as well be SEIU (it is not, per se, a union bill but close enough for blogging standards.) It contains no real mechanism for organizing and discussions with opponents, including one I had with a good friend yesterday, typically involve concerns around incrementalism. The fear seems to be that if the union accomplishes something in legislation around this system that the next step will be more invasive and followed by the eschaton.

Many who know me and the few who read this blog may remember that I don't love this bill. But I do think it's a small thing and unworthy of vigorous opposition. Change works best in small steps and if incrementalism is a fear advocates indulge in, a frozen system that can't improve is the natural result, kind of like the one we already complain about. While we are counting increments to fear, here are some the bill contains, other than a unionized workforce:

1. Accountability. The evaluation scheme outlined in the bill seems a little questionable to me, requiring comparison to a control group but offering no incentive or mechanism to establish that control group. To call the evaluation outcome measurement one has to assume that better-trained, longer serving staff automatically lead to better outcomes, which is not unreasonable but is still a process measure. Despite the flaws, the proposal is the first in a while that attempts to measure its own success. If this bill passes, actual valid quality accounting might become a standard part of our system in my niece's lifetime, although it would be rash to presume that it will.
2. Professionalism. From many perspectives, receiving healthcare benefits and regular training units can be more or less indistinguishable from professionalism. Professionalism does not grow more vigorously in a culture of CEUs, like mold in agar, but it is at least true that training and benefits can confer the appearance of a professional class. If the pilot project is successful in making staff more professional-seeming, there is a risk that one day the cowardly lion, tin man and scarecrow will end up agency executives if they aren't already.
3. Incremental Incrementalism. AB 649, a massive, systemic goliath of a bill failed. Last year, a more ambitious predecessor to this bill failed as a gut-and-amend amendment. If AB 1427 passes, we must be concerned that eventually, massive labor unions, trade associations and other special interests will put forward bills encouraging italicization of ambiguous words using permissive language.