Thursday morning, Gov. Paul LePage’s streamlining task force is scheduled to begin some of its most difficult work. On the agenda: The Department of Health and Human Services.
DHHS is everybody’s favorite whipping target. Just saying the initials conjures up carefully crafted images about everything that’s wrong with government today. Too big. Too slow. Too inefficient. Too much fraud. Too much waste. Too much abuse.
It’s all just too much.
When I say the attacks on DHHS are carefully crafted, I mean the department’s image has been under near constant attack for more than a decade, probably longer. Anti-government crusaders have attacked the agency at every turn and made it into a caricature.
Part of the problem is one of politics. LePage and his allies in the Republican majorities in the House and Senate rode an anti-government wave to power. They have made no secret of their disdain for DHHS and the services it provides, yet now they are empowered to “fix it.”
And part of the problem is that the Department of Health and Human Services deals, on a daily basis, with some of society’s hardest, most chronic and most complicated issues facing our state.
You could just as easily call it the Department of Human Tragedy and Suffering.
When families fall apart, it is often the department that has to attempt to put the pieces back together, sometimes imperfectly and with mixed results. When poverty soars and children don’t have enough to eat, it’s DHHS that tries to make sure there’s food on the table. And when someone stands on a bridge, ready to jump, it’s often left to DHHS to try to figure out why and make sure the person gets help.
Sometimes — dare I say it, most of the time — the department does its work well and unnoticed. But on those occasions when it falls short, and it does fall short, the results can be tragic.
Often DHHS is discussed in terms of dollars spent. For as long as I’ve followed state government, and that’s moving on past 20 years, there are government audits, finding reports, unexplained trend lines, spikes and computer woes. That’s true in Maine, and it’s true almost everywhere.
And every administration is challenged to prevent these problems.
But if you want to understand the root cause, we have to look in the mirror at ourselves.
DHHS administers the state’s Medicaid program, which is largely funded by the federal government but also requires a state match. The rules around Medicaid are constantly changing, on both the state and federal level. What’s OK today can turn into an audit finding tomorrow and into a fine 10 years down the road.
Most policymakers talk a good game about reining-in health care costs, but when it comes to the hard work, don’t count on it. They want to reduce the cost of Medicaid in the state budget, but they are reluctant to go after the biggest cost drivers: hospitals, pharmacy and drug costs, nursing homes, the disabled and the elderly.
Even so, the reimbursement rates for things like dentists and doctors aren’t adequate, making it difficult to find practitioners willing to see Medicaid clients.
So-called optional services are also difficult to discuss. Of course, optional services only mean medical aid that’s not required by the federal government. If you have chronic diabetes, a podiatrist doesn’t seem optional. If your child has a permanent brain injury, rehabilitation doesn’t seem optional.
The simple solution: Take health insurance coverage away from the poorest people — the childless adults who receive Medicaid coverage. It doesn’t matter that such a move doesn’t really save money. It just hides the cost of care, shifts it onto privately insured Mainers and guarantees that the poorest among us receive little health care. It’s easier to attack them; their voices are often the quietest when the debate gets loud.
Thursday, the streamlining task force is going to hear the governor’s proposals to reduce spending in DHHS. There will be no public hearing, and little opportunity for the task force to hear from anyone outside the LePage administration.
The stage is set for a bad outcome for DHHS and the people who it serves.
David Farmer is a political and media consultant. He was formerly deputy chief of staff and communications director for Gov. John E. Baldacci and a longtime journalist. He is currently working on the Yes on 1 campaign. You can reach him at email@example.com. Follow him on Twitter @dfarmer14.