美國政府機構(gòu)需要加快數(shù)字化改革
近來從華盛頓傳出的好消息不多。但有一個例外：幾周前，美國退伍軍人事務(wù)部(Department of Veterans Affairs)宣布，已敲定計劃、將引進新的統(tǒng)一電子健康檔案系統(tǒng)。
This marks a big leap forward for the VA, which has hitherto kept its records in a fragmented manner. For the first time, it will be integrating its systems with those of the Department of Defence. This will ensure that, instead of sitting in limbo for months, records will be transferred as soon as servicemen and women leave the military.
這標(biāo)志著退伍軍人事務(wù)部向前邁進了一大步，該部門到目前為止一直以一種分散的方式保管健康檔案。它將首次把本部門的系統(tǒng)與國防部(Department of Defence)的系統(tǒng)整合到一起。這將確保每名軍人一退役，他們的健康檔案就可以轉(zhuǎn)移出來，而不必再苦等數(shù)月。
“For almost two decades, Congress has been imploring the Department of Veterans Affairs not only to deliver on our promise to veterans, but also to innovate and modernise,” declared Jeff Dunham, a Republican congressman from California, writing in The Washington Examiner recently. “Now under new leadership, following years of frustration, corruption, scandal and abuse, the VA is taking the initiative to deliver the care and services that our veterans [need].”
“近20年來，國會一直在懇求退伍軍人事務(wù)部，不僅要兌現(xiàn)我們對退伍軍人的承諾，也要進行創(chuàng)新和現(xiàn)代化，”來自加州的共和黨議員杰夫•鄧納姆(Jeff Dunham)最近在《華盛頓觀察報》(The Washington Examiner)上撰文稱，“如今，在經(jīng)過多年的挫敗、腐敗、丑聞和行為失當(dāng)后，退伍軍人事務(wù)部在新一屆領(lǐng)導(dǎo)的帶領(lǐng)下，正積極主動地提供我們的退伍軍人(所需的)關(guān)心和服務(wù)。”
I dare say some readers’ eyes are glazing over at this point; the finer points of government digitisation don’t normally provoke media headlines or voter passion. But it is worth pondering this story — or, more accurately, the fact that it wasn’t much of a “story” at all for our current Trump-obsessed media.
我敢說，有些讀者現(xiàn)在可能有些走神;政府?dāng)?shù)字化這樣的細節(jié)通常不會登上媒體頭條或者激發(fā)選民的激情。但這條新聞值得琢磨——更準(zhǔn)確地說，值得琢磨的是如下事實：這條新聞對當(dāng)前只顧著報道特朗普的媒體來說都算不上一條“新聞”。
That the VA announcement passed without much notice says a lot about what is wrong with our concept of what matters in government today, and the way we are increasingly treating Washington as an entertaining reality-TV show, without noticing the things that government actually could — or should — do.
退伍軍人事務(wù)部這則聲明沒有引起太多注意，極大地暴露出我們對當(dāng)今政府中什么事情重要的認知偏差，以及我們越來越把華盛頓當(dāng)作一檔很有娛樂性的電視真人秀節(jié)目，而沒有留意政府實際上可做或應(yīng)該做的事情。
In any rational world, it would seem entirely sensible for the VA to create integrated healthcare records. Many observers might consider it odd that the department has not already done so. After all, America is a place of cutting-edge technology and digital entrepreneurial skills — just think of what Amazon, Facebook and Google have done. It is also a place where companies have been using digital technology for years; where the healthcare system accounts for a sixth of all economic activity; and where there are some 21 million veterans (equivalent to the entire populations of Norway, Sweden and Denmark combined).
在任何理性世界，退伍軍人事務(wù)部創(chuàng)建完整統(tǒng)一的健康檔案似乎都是完全合理的。許多觀察人士可能感到奇怪——該部門居然還未完成這件事。畢竟，美國擁有大量尖端科技和數(shù)字創(chuàng)業(yè)技能——只需想想亞馬遜(Amazon)、Facebook、谷歌(Google)取得的成就。美國企業(yè)多年前已開始利用數(shù)字技術(shù);美國的醫(yī)療體系占全部經(jīng)濟活動的六分之一;美國有約2100萬退伍軍人(相當(dāng)于挪威、瑞典和丹麥人口的總和)。
For the past two decades, however, the VA has repeatedly failed to implement an integrated record-keeping system (never mind that it has spent about $2bn on feasibility studies in recent years). While these delays can be blamed partly on mismanagement, the issues go well beyond that.
然而，過去20年，退伍軍人事務(wù)部一直未能建立一個統(tǒng)一的健康檔案保管系統(tǒng)(雖然近幾年已在研究建立這一系統(tǒng)的可行性上花費了約20億美元)。不斷拖延部分可歸咎于管理不善，但問題遠不止于此。
Much of the US’s civilian healthcare system is fragmented too: while it is easy to transfer healthcare records between doctors in a country such as the UK, it is very difficult to do so in much of America. And the VA is certainly not the only one with archaic practices: although there are corners of the public sector that are using the latest technology — such as the City Halls in New York and Chicago — most federal agencies have been almost as slow as the VA to introduce 21st-century ideas.
美國的平民醫(yī)療系統(tǒng)大部分也不統(tǒng)一：盡管在英國等國家，在醫(yī)生之間轉(zhuǎn)移健康檔案很容易，但在美國大部分地區(qū)卻很難做到這一點。退伍軍人事務(wù)部肯定不是唯一使用原始方式的機構(gòu)：雖然部分公共部門正在使用最新的技術(shù)——如紐約和芝加哥市政廳——但多數(shù)聯(lián)邦機構(gòu)在引入21世紀(jì)的理念方面，幾乎都像退伍軍人事務(wù)部一樣緩慢。
The good news is that moves to change this are under way. Various private-sector entrepreneurs are launching innovations in healthcare IT, and there are campaigns to upgrade public-sector digital know-how. The non-profit “Code for America”, for example, is campaigning for computer geeks to volunteer to spend a couple of years working for government, in much the same way that the better-known “Teach for America” encourages graduates to work for a time in the country’s public schools.
好消息是，改變這一狀況的行動正在進行之中。許多私營部門創(chuàng)業(yè)者都在醫(yī)療信息技術(shù)領(lǐng)域發(fā)起創(chuàng)新，還有各種旨在提升公共部門數(shù)字技術(shù)的活動。例如，非營利組織“為美國編程”(Code for America)正在爭取讓計算機極客志愿為政府工作幾年，這與更為人熟知的“為美國教書”(Teach For America)鼓勵畢業(yè)生在美國公立學(xué)校工作一段時間非常相似。
What’s more, some White House officials, such as Gary Cohn and Jared Kushner, now seem keen to bring better management and tech skills into government. This week, for example, President Trump, Cohn and Kushner convened a meeting of tech CEOs to discuss how to launch a revolution in the way the federal government uses computers — and claimed this could deliver a trillion dollars in cost savings over 10 years.
此外，現(xiàn)在的一些白宮官員，如加里•科恩(Gary Cohn)和賈里德•庫什納(Jared Kushner)，似乎熱衷于將更好的管理和技術(shù)能力引入政府。例如，不久前，特朗普總統(tǒng)、科恩和庫什納召集科技公司首席執(zhí)行官們開了一次會，討論如何在聯(lián)邦政府使用電腦的方式上發(fā)起一場革命——聲稱這樣做將在10年內(nèi)節(jié)約成本1萬億美元。
“We are here to improve the day-to-day lives of the average citizen,” Kushner said, pointing out that the federal agencies are so fragmented they currently maintain no fewer than 6,100 data centres. These, he argues, could be streamlined to create a more efficient structure, just as the VA is now attempting to do.
庫什納說：“我們在這里是為了改善普通公民的日常生活。”他指出，各聯(lián)邦機構(gòu)非常分散，目前共維持有不下6100個數(shù)據(jù)中心。他表示，可以通過重組和優(yōu)化這些數(shù)據(jù)中心，來打造更高效的結(jié)構(gòu)，正如退伍軍人事務(wù)部正嘗試做的那樣。
This is sensible stuff — exactly the type of common-sense action that governments should take (and that businesses do take every day). But even at the best of times it is hard to get voters — or media consumers — particularly excited by this sort of basic but important reform. And right now it is doubly hard.
這個辦法靠譜——正是政府憑常識應(yīng)該采取的行動(企業(yè)每天都在這樣做)。但即便情況最好的時候，這種基礎(chǔ)但重要的改革也很難讓選民或媒體受眾感到特別興奮。而現(xiàn)在更是難上加難。
That is partly because the media are mesmerised by the investigations surrounding Trump and his entourage, including Kushner. But it is also because Trump himself keeps creating distractions with his own deliberately incendiary tweets, making it difficult for voters to pay any attention to the sensible reforms that advisers such as Kushner want to promote.
部分原因在于媒體過于關(guān)注圍繞特朗普及其團隊(包括庫什納)的調(diào)查。還因為特朗普本人故意發(fā)布煽動性推文、不斷制造各種干擾，使選民難以靜下心來關(guān)注庫什納等顧問希望推進的合理改革。
Therein lies a huge missed opportunity. It would be comic if it were not so tragic; we’d better just hope those VA reforms fly.
這其中蘊含著一個巨大的錯失的機遇。如果情況不是如此悲劇的話，看上去還有些滑稽可笑;我們最好還是祈禱退伍軍人事務(wù)部的這些改革能夠成功。
[email protected]; @gilliantett 插圖/肖納格•雷(Shonagh Rae)
