Citizen Oversight for the Federal Health Agencies

A Framework for Democratic Oversight of the Federal Health Agencies

Existing oversight mechanisms for the federal health agencies are completely inadequate. Opaque government bureaucracies shut out citizens. Waste, inefficiency and corruption are marbled into the system. Cutting waste requires many changes, small and large, across the government. Some limited auditing of the system is occasionally done, but even when audits find flaws, problems mostly go unaddressed.

By decomposing government agencies into small, comprehensible subunits and pairing each subunit with a citizen oversight committee, America can channel civic energy into mechanisms for government oversight and improvement. Citizen juries can be given manageable tasks, make targeted recommendations, and act as a focal point for interaction with activists. Additional citizen oversight juries can work across the system on larger structural issues.

Citizen juries can gather feedback and ideas from the public and collate and give this feedback to the relevant areas of the government. They can evaluate the performance of particular areas, suggest improvements, publicize issues, and bring unresolved issues to other areas of government.

Citizen oversight juries would act as agents of the public to ensure that the piece of government within their purview functions well. They are to work collaboratively with both the people in government as well as the general public to improve the functioning of their oversight area.

How Citizen Juries Function

A citizens jury is a working group or oversight committee that can vary in size from 3-12 people. Citizens oversight juries would function similarly to traditional blue ribbon panels. Groups of citizens would be selected at random, similar to the selection process currently used for criminal or civil juries. However, instead of evaluating the facts of a legal case, the oversight juries would be given the task of evaluating the state of a particular piece of the bureaucratic government, and instead of rendering a verdict, the oversight juries would use their common sense and intelligence to look at a situation, determine the primary issues, examine data (financials, reports, interviews, documents, emails, etc.), and consult with concerned citizens and experts. With this information, the oversight juries can write reports and make recommendations. The jury can then take steps to see that these suggestions are heard by the proper authorities and get wider publicity. They can suggest budgeting changes, rationalizations, reorganizations, and policy changes. The juries are to act as the agents of the general public to see that their area of oversight functions as well as possible.

The pairing of oversight juries with the federal health agencies

The federal health bureaucracy is massive and beyond the comprehension of any individual. Understandable subunits can be created by breaking the agencies into many small pieces. Each of these subunits can then be paired with a citizens oversight jury. These units can represent individual departments, functional areas, or funding steams. The size of these evaluation units can be flexible and situation specific. As a rough approximation, each unit could cover about 100-200 employees or $10-20M in spending. For issues that transcend individual departments, citizens juries can be created on cross functional or thematic concepts.

A mature version of this system would decompose the federal health bureaucracy into 800+ sub units, and each sub-unit would be paired with a citizens oversight jury. Each jury might have 4-12 people, so perhaps 4,000 - 8,000 citizens would participate in citizens oversight juries of the federal health agencies each year. Most of this participation would be part time. Participants in juries would be paid for their time, so in its mature state, the cost of this system could be about 1% of these agencies budgets. This cost is significant, but the efficiency gains brought about by a functioning oversight system would pay for itself many times over.

How citizens are selected to be a member of an oversight jury

Members of the citizen juries should be independent of the system which they will be charged with evaluating. Random (or pseudo-random) selection can be used to generate jury members who are independent of the system and the biases of other selection processes (appointments by interested parties, or elections which can be influenced by special interests). As a start, the existing system for selecting people for participation in legal juries can be used. Over time, refinements of this system using micro-elections within communities of 100 or so people can be used to find people respected by their neighbors who have the time and inclination to participate on an oversight committee.

As a transitional phase on the way to full implementation, a pool of jury candidates could be created by allowing volunteers to submit their names for consideration. Jury members could then be picked at random from this pool. This method for selecting jury members has the advantage that interested, dedicated volunteers can be better informed and motivated than the general public. However, the self selection of the volunteer process will lead to juries which are not as representative of the general public and also allows for a vector of corruption as self interested parties will be inclined to participate disproportionately. Conflict of interest filters can help mitigate some of the problems with self interested participants. Whatever system is deployed needs to be monitored and modified to respond to threats that develop.

The time commitment for jury participation may be significant, so selected citizens should have the option to decline service. Jury service should be compensated.

OpenFOIA and transparency tools to allow for the better functioning of citizen oversight

Citizens juries need access to as much relevant information as possible in order to perform their duty. Technically, FOIA laws allow the public to have access to government emails and documents. However, in reality, the large effort and overhead required to get access to this information limit the availability of government data and prevent FOIA from living up to its potential.

OpenFOIA is the idea that instead of a request based process, computer systems would be built that allow for all relevant government data to be searched on demand. Once these systems are built, the cost of complying with FOIA requests will drop to almost zero, and the public will have access to the full range of emails and government documents that exist. With access to this broad set of data, citizen oversight juries can more accurately access the functioning of the government.

AI agents to assist with the oversight process

With the recent breakthroughs in AI technology, the potential now exists for AI agents to be built which can process and summarize large amounts of data. These agents can be trained on all of the data relevant to a topic area as well as best practices from around the world. These agents can help with the task of analyzing the huge amount of data relevant to a topic area and can empower the members of citizens oversight committees.

Government funding, tools, and assistance to enable to Citizen Oversight Framework

Running and managing the structure of citizen oversight juries will take focused effort. It cannot be done on a purely voluntary basis (although contribution by volunteers is to be welcomed). Operating citizens juries will require a budget and an accompanying support bureaucracy.

The support bureaucracy would include the following areas:

• Selection, staffing of juries - including maintaining the jury rolls and working with states and other authorities. Communication with jurors.

• Training and best practice and process communication and training. Training for how jurors are to work and what they are to do and the support of a continuous learning process.

• Technology support

• Support for publishing reports

• Support for engaging with other areas of govt to implement recommendations

• Support for the process of determining the appropriate mapping of juries to the bureaucracy

• Support a culture of participation in citizens juries

An incremental plan to introduce citizens juries to the health system

• Start as a volunteer effort by engaged citizens

• Have the volunteers map the relevant agency into oversight areas

• Create a volunteer based oversight committee for each oversight area

• Create goals and guidelines for how these oversight committees are to function

• Support the oversight committees with training, process guidance, data, and tool to help them do their job

• Connect the volunteer oversight committees with the appropriate people associated with each area of government

• Get official buy in from the people within the government

• Take the informal, volunteer oversight committee model and transition to an official, government supported model

• Start with the health agencies (HHS, FDA, NIH, CDC) and demonstrate success and then expand to other areas of government.