Moles and bumps, fingers and limbs, people and hospital programs – all and more have fallen to my knife as a physician or hospital administrator. It’s always been for a greater good, but it has been some of the most nasty, difficult work I have ever done. For those involved in any side of state government budget battles around the country doing the same thing, here are Dr. Slash’s Rules for Cutting Costs, learned painfully and bloodily over the years.
1. No matter how tough the fight, never forget that you have to live with the people on the other side after it’s over. Two weeks from now you may need some of them on your side in another issue. Two years from now you might apply for a job in the company where one of your opponents works, find out her daughter is the woman your son wants to marry, or wake up on a future November Wednesday with her party now in the majority.
2. Related, always treat your budget battle opponents with respect. With few exceptions, the people who disagree with you are like you; smart, principled, and caring, and love America as much as you do. Pick apart their arguments, not their character. Their ideas just might contain a piece of the ultimate answer to the problem. Remember that supreme confidence in your approach as the only right answer to a complex, difficult issue is usually arrogance born of ignorance or vise versa.
3) Treat those whose lives your proposed budget cuts will affect directly with particular dignity and respect. Casting aspersions on the integrity, work ethic, honesty and commitment of people whose positions you are cutting, programs you are curtailing, or family futures you may be jeopardizing is shameful, brutish behavior for which any good mother would send you to bed without dessert.
4) If you are opposing some cut, put an alternative way to save that money on the table. When cuts somewhere are unavoidable, it is an irresponsible luxury to simply oppose cuts and leave the search for difficult alternatives up to others. If I were king of the forest (with Toto and Dorothy at my side, of course) you would not be allowed to testify in opposition to one particular cut without proposing an alternative.
5) Don’t believe anyone who says cutting their program will just make things more expensive down the road unless they can actually provide real data that proves them right. Everyone says cutting their program just increases costs down the road, but only some of them are correct. Those budgeted programs with track records of cost-saving success should only be cut after those without proven records. Cutting things in one year’s budget that truly result in higher costs in a future year’s budget just kicks the cost and responsibility can down the road.
6) Related, let evidence of what programs work drive the car, a working relationship with those around the budget table ride in the front seat, and make personal ideology about what we should do ride in the back.
7) Separate things you are considering for the ax into three piles: it’s nice to have, it’s good to have, and it’s a must have. This bucket list exercise is still a battle, but it’s often surprising how much consensus can be found when those faced with budget cutting decisions are first required to rate everything that way. What often seems like a must have cannot stand up to the simple question, “Really? Must have, or just really good to have?”
8) Share pain – the bigger the cuts, the more we should all bear a share. For the wealthy, that might be temporary tax hikes. For other citizens it will might be cuts in services and favorite programs. When a state budget gets cut by 20 percent, every citizen should own a little of the blood on the floor. That includes elected representatives, whose salaries, health insurance and pensions should also be dinged.
9) Whether a legislator, governor or just a citizen fighting for your cause, be nice through this work. If you are, the scars it will leave forever will be a bit smaller.
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.