Saturday, May 08, 2010

Government Budget Discussions

The commisioner of the Department of Health and Human Services for NH - who I understand is a very nice guy - held an information meeting for employees of the Division this week. What was drummed home was how hard they are trying to not lay people off and to keep up services during hard times. In this, they spent a fair bit of time on how poorly the state legislators understood our needs and our problems. All week we have been hearing grimly satisfied stories about how stupid they were when they came to visit, seeing the reality of what their decisions mean.

Commiserating was the order of the day, including the statements from the higher-ups who were clearly focused on the political happenings and what they meant for us. The problem, it is clearly implied, is those irritating legislators who don't really understand about mental health and how much it costs to do it right. There is a lot of talk about educating legislators, and calling them up and letting them know how you feel. (Note the last word of that sentence.)

I've been hearing this for over thirty years, and have another take. Why is it that it always takes these guys by surprise that the legislature doesn't know very much about what we do? Every two years we hear the same thing. Those darn poopie-headed legislators. If only they knew. I submit that it is irresponsible of the administrators not to take this into their calculations after this many repetitions. How is this an unexpected development?

Of course they don't know much about our field. Nor about tourism, infrastructure, schools, motor vehicles, or any of the hundred other things they have to make decisions on. This is what government is. There is no magical legislature somewhere where the people all get it about everything. This is a reality of life. They are never going to know a lot about the reality of any government department. They are mostly reasonably intelligent people who want to learn the most important things about each of the areas in order to make some sort of semi-informed decision. That is all they are ever going to be at best. Even under Obama, children. Even if you elect a 50% Democrat 50% Green legislature. They will just be uninformed but somewhat more sympathetic to you.

What we call educating the legislature is mostly an exercise in getting them to adopt our world-view about what's important. That's not their job. Repeat, that's not their job. If you can get a few of them to see it your way so they will vote how you like and maybe influence some other legislators, you still haven't educated them. You just have equally ill-informed people who you perceive as being on your side.

When government budgets get cut, all departments go into the zero-sum game of trying to show that what they do is more important. They hold rallies. They form action teams that call legislators or try to get news stories out. People who know people talk to other people behind the scenes. Horror stories (or veiled threats) of how terrible things will be if we can't do our job the way we want are darkly circulated. Then when the hard decisions have to be made, some other guys can be blamed for not understanding. What we who know the field will not do with a scalpel, someone who doesn't know the field comes in and does with an axe. And we complain - look, they used an axe and did stupid things. Quelle surprise.

Apparently, preserving our self-righteous feelings of how important we are, and how right our world-view is, is more important, when push comes to shove, than the job our agency does. (Never mind the importance of keeping the costs down for the people who pay for it.) We would rather stand proudly and insist to all the world how inhumane all this is, and refuse to go along with it, than be prepared to get as much work done for our customers under any circumstances. This accusation, BTW, I level more at those higher-up, who don't want to be considered in the same batch as those stupid, inhumance legislators. We lower down are pretty used to making due with whatever comes down the conveyor belt.

Do you want me to acknowledge the reality that citizens in general, and the legislature in specific, don't understand how expense mental health treatment is, and it would be great if folks knew? Sure. As an example, local hospitals keep trying to open Designated Receiving Facilities for mental health, because the amount of reimbursement they see getting per patient looks like easy money. They're sure they can cut costs better than any dumb old government agency. Then they open it and find that mental health care (or DD care, or elderly care) is far more labor-intensive than they thought and costs a lot. So they get out of that side of the business. It's very expensive. To do it right, it would cost us a lot more. Legitimate costs, not just crap like Wellness Fairs that I always complain about. Oh, if only people knew how expensive it was, we'd get more money. No, if people knew how expensive it really is they wouldn't think we could do everything for everyone and elect people who tell us we can, and still punish the mean old corporate money-makers who fund this whole enterprise. If the citizenry knew, they would say "Holy crap! We can't afford that unless we cut lots of other cool stuff that makes us feel good, plus let the economy go into Hong Kong-style freewheeling capitalism with lots of risks. Can't have that."

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