Is Maine really General Motors with an ocean view? In one big respect, yes; both are saddled with great debt. There the analogy ends.
GM has a fine friend in the feds, which gave it a nearly $50 billion bailout. Maine has no such advantage. It does have a wise law requiring a balanced budget yearly but the budget cuts historically are grossly disproportionate.
Too many leaders proclaim “Everybody’s on the table!” Oh, really? Who didn’t make it to the table? Of those on the table, some get checkups, some minor operations. Others with little political power have major organ removal yearly. A few not on the budget table pass go and get tax concessions which increases tax burdens for the majority.
Shouldn’t our leaders who proclaim “everybody’s on the table” really put “everybody” on the table, including themselves? They took an oath of office to support the Maine Constitution, which calls for establishing justice, ensuring tranquility, promoting our common welfare, etc. Serving the people is the paramount reason for Maine state government, not state employment. The guiding principle should be: Cut services last! Cut inequities first! Everybody on the table should mean everybody not only for a fair share of budget cuts but an equal share of fair regulations plus a level playing field that includes same reimbursement and regulations for same or similar services.
Time’s running out. Maine’s the oldest state in the union. Our percentage of youth is declining. The implications: less income overall and more demand for social and health services. Maine won’t escape its demographics nor will pushing greater costs into the future assure a future.
By 2012, “one-time-onlys” and federal stimulus money will be gone. The clock ticks toward 2028, when a gigantic promise of $6.3 billion comes due to retired and current teachers and state employees for their health and retirement benefits. In the next budget cycle the retirement component alone rises to about $350 million. Once all the other debt is added in and with the end of the federal stimulus money, Maine might wish it were GM with an ocean view.
What can be done? Real serious state government restructuring would help greatly. For example, rebalance the service delivery systems, particularly state government’s role. It would save multiple millions.
Much clearer roles and responsibilities are needed. The Department of Health and Human Services performs state services in the community such as outpatient, medication clinics, foster care and case management services. They duplicate community agencies at much higher cost.
The state grants itself reimbursement rate increases while giving numerous rate cuts in mental health, developmental disabilities, home health, nursing homes and others as well as not paying off their hospital debt. The state exempts itself from the requirements of “managed care” while imposing it on others.
All these factors, including higher reimbursement rates for itself, mean more cost and less services. The truth is the state can’t compete against other providers without these built-in special advantages. With a 62 percent fringe benefit package and generally higher salaries how could they? The state claims it’s “the safety net” but for whom?
Why are “shadow positions” not in the state employee count? These are positions contracted by the state to organizations, and then reassigned to do state-related work. In the last several years, community agencies have had to cut many thousands of jobs. Services have been lost to those in great need but it appears that no one in government or the media is evaluating the actual and unintended consequences of all the services and the jobs cut in the community. Shouldn’t the primary focus be on the people of Maine?
Two simple questions need to be asked: What are the most important services? How can they be provided creatively and cost effectively?
DHHS should emphasize comprehensive policy, health and human services planning and oversight as its major functions. It should phase out direct services and support more cost effective community agencies and correct policy and access inconsistencies across Maine’s health and human services system. Policies that favor one segment of providers over others should be eliminated.
Federal data show Maine’s Medicaid beneficiaries charges per service category range from well below national averages to highest in the nation. Why? If DHHS truly focused on this major core role it might also be able to solve its computer systems problems and not spend millions for consultants, managed care companies or even need shadow positions. The people of Maine would be better off for it.
Joe Pickering Jr. is the former executive director of Community Health and Counseling Services in Bangor.