Things They Should Study: what would it actually cost to improve public services?

As I sat in the ER waiting room for six hours, I found myself thinking "What would it take to completely eliminate the wait times?"

And the thing is, we don't know.  Because, as I blogged about at the time of the Drummond report, governments are reluctant to do anything that could even remotely be interpreted as even thinking about giving the slightest consideration to something that could possibly lead to taxes being raised.

But, for all we know, optimal cost-effectiveness could be right there on the other side of an expenditure increase. And we'll never know if we don't study it.

They should study the cost of all kinds of different service increases, ranging from tiny incremental increases to levels of service beyond our wildest dreams.

To use the emergency room example, what would it cost to decrease wait times by 10%? 20%? 50%? 80%?  What would it cost to get the median wait time down to an hour? What would it cost to get every patient's wait time under an hour?  What would it cost to get the median wait time down to zero?  What would it cost to have hospitals so well-staffed that employees spend an average of 20% of their time with literally nothing to do, so there's extra leeway in case they get an unanticipated rush of patients?

That last example would make some people think "That would be a ridiculous waste of money - to deliberately plan for staff to be doing nothing!" And that's why it's included in the range of scenarios being studied - we need to study everything ranging from incremental improvements to drastic improvements to the point where the improvements are clearly no longer going to be adding value, to make sure we don't miss the point of optimal value.

Sometimes the optimal value for money involves spending money.  For example, adding data plan to your cell phone account costs money, and a data plan adds value. To make the decision about whether to get one, you have to look at the information about how much value it adds and how much money it costs - which includes looking at the cost of an unlimited plan, even if cheaper plans do exist.


Sometimes the optimal value for money involves deficit financing.  For example, there are situations where buying a home is better value in the long run than renting, even though you have to go into debt to do it.  To make the decision about which is best value, you have to look at all the data and run numbers for various scenarios - which includes looking at the cost of your dream house, even if cheaper housing options do exist.

Politicians like to talk about value for money, but they only ever seem to look at ways to save money.  They should also systematically study ways to add value, in order to find the point of optimal value for money.