Policy Futures for Public Institutions

Introduction

What is the future of healthcare? Of immigration? Or of capitalism? We often envision the future in terms of gadgetry, but the future has as much to do with how we codify our beliefs and values as it is about how we codify data and algorithms. While companies use foresight practices to drive engineering, governments use it to drive public institutions: our laws, our programs, our politics. 

As a recent UN publication stated: “Foresight approaches in policymaking and statebuilding represent an opportunity for decision-makers to consider and integrate the aspirations of its populace in the design of institutional reforms and for states to secure, and restore faith in, the degenerating social contract with citizens.” Now more than ever, we need policy designed for the future.

Beyond Tech

Most foresight work centers on technological innovation. It is focused on questions regarding the development of new, often physical, and very appropriable things. How will, for example, a new material to store energy, a new mechanism to process information, or a new medium on which to share content affect the wider world? How will the wider world affect their development?

This is not at all surprising. Technological artifacts are obvious drivers of innovation and social change; we can see them and touch them. The tools we hold in our hands embody our social reality and symbolize the era in which we live. The sword. The sextant. The smartphone. Yet the things we can hold, that we can own, represent only a portion of the innovation that creates value for society.

Innovation can take social forms as well as physical forms; it can yield public goods as well as private goods. From the dawn of civilization until our present day, institutions such as legal systems, political systems, and religious systems have created value for humans who share social spaces. Innovations of public institutions range from Confucianism to constitutional democracy.

Indeed, the concept of civilization seems to have more to do with advents like these – ones that are not physical and not ownable, rather than those that are. Foresight work can and should be used to focus on institutional innovations in the public sphere as much as technological innovations in the commercial sphere. The methods of structured foresight can be applied equally well.

Policy Futures

There is no doubt that the public sphere is changing. As a nation, our demographics are increasingly diverse, our assets are more unevenly distributed, and our politics are increasingly tribal. Because of such mounting and escalating changes, our democratic institutions are being stressed as never before. It is more important than ever to anticipate changes in these institutions.

Broadly speaking, I am advocating for the use of “policy futures.” My use of this term is meant to include policy in the strictest sense (i.e. the laws produced by legislative bodies), as well as more broadly in the directives of executive bodies (i.e. presidential orders and departmental administrative orders), the rulings of judiciaries, and the platforms of political parties and individual candidates.

There are already several policy prediction tools out there. PredictGov, for example, forecasts the likelihood that a bill will become a law by using a machine that analyzes the text of the bill itself and compares it to past measures, including their successes and failures. Good Judgement crowdsources the opinions of members to forecast a range of social and organizational changes.

Yet predictions only extrapolate our current understanding of the world and yield a narrow vision of the future. Sound foresight work must also be anticipatory; it must offer a variety of plausible futures, ones that capture the power of imagination as well as logic, so that we are prepared when unpredictable happens, as it so often does. Scans and scenarios are two foresight tools to do just this.

Two Tools

A scan is a systematic exploration of the world around us to detect anomalies – outliers that could portend a new state of affairs. Typically, this means reading a lot of recent articles from different sources, categorizing them, and hypothesizing impacts. Scans help us stay ahead of the game, to make decisions or frame issues before others can. Scanning is watching the future as it emerges.

Scenarios are stories set in the future that explore how the world could be different and how different players may act in a variety of plausible realities. Scenarios are typically structured around the changes identified by a scan. Scenarios let us stress-test our strategies, mental models, and assumptions. Because they are not predictions, scenarios help prevent failures of imagination or black swans.

Scans and scenarios align well with established theories of policy change, particularly Cohen, March and Olsen’s garbage can model and Kingdon’s three streams model. Both hold that policy happens when windows of opportunity allow existing sets of problems, solutions, and stakeholders to mix. Before such windows open, we can scan for these components and design scenarios as combinations.

Moreover, while these tools are most often used for technological innovation, their use is also consistent with theories of policy innovation. Walker and Gray show how policies on education and justice reform diffuse from state to state just as new technologies diffuse from application to application; Mintrom suggests that “policy entrepreneurs” shepherd this process.

Health Policy

At a large, federal health care agency, I have used policy futures to advance the agency's goal to analyze pending legislation and administration priorities, then proactively develop internal policy and regulations to adapt its health care delivery system within an increasingly volatile, uncertain, complex, and ambiguous health care environment.

I helped the agency establish a system for scanning the environment for emerging health, legislative, and policy events to reveal pertinent issues and derive the fundamental drivers of policy innovation. We can then use this knowledge to define a set of plausible alternative health policy futures, help agency leaders practice operating in them, and make recommendations for policy positions.

While still early in this process, the scan has revealed several drivers of policy change that could affect people's health. Particularly interesting is the increasingly complex health care landscape defined by policy at the state-level. A lawsuit brought by 20 state attorneys general seeks to abolish Obamacare. In Arkansas, work requirements are making fewer people eligible for Medicaid.

And then there are equally interesting developments in the private sector. The new company formed by Amazon, Berkshire Hathaway, and JPMorgan is blurring the traditional lines between pharmacies, insurers, and providers, as is the purchase of Aetna by CVS. To what degree could Obamacare, Medicaid, or care provided by these firms compliment (or substitute for) government services? Should they?

Conclusion

This federal agency is not the only organization that must contend with questions that have no easy answers, that must confront a future that is unpredictable, or that must continue to design and redesign institutions that meet our changing needs. There are many – indeed, too many – areas where democracy itself requires innovation, and policy futures can help make strategic decisions to that end.

The US federal government, state and local governments, governments of other countries around the world, and the governance structures of international bodies are all designed to change with the times, to grow as we grow. It is time to supplement that flexibility with the creative discipline of foresight. It is time to craft policy futures.