Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, January 14, 1993 TAG: 9301140450
SECTION: EDITORIAL PAGE: A-15 EDITION: METRO
SOURCE: RAY L. GARLAND
DATELINE: LENGTH: Long
REINVENTING THE WHEELS OF STATE GOVERNMENT
IN DETAILING last week the hard fiscal choices facing the General Assembly, it was suggested that only by devising "new philosophies" for the delivery of basic state services could we expect to keep costs from expanding faster than our ability to fund them.The term "new philosophies" was vague, so let's flesh it out. Here are a few fundamental changes that legislators might seek to bring about, offering a realistic hope of making better use of what we have:
\ Outside management study: A recent national news story said that the North American operations of the Ford Motor Co. are producing about as many cars as they did 20 years ago, but with half as many employees! "Jobs," you cry, but had Ford not made these adjustments, there might be even fewer jobs today, or none. Among Fortune 500 companies this story has been repeated many times: doing more with fewer people. But government, especially at the state and local level, has continued to expand rapidly.
Now, it's certainly a fact that labor-intensive jobs in the service sector are more resistant to productivity gains than in most spheres of manufacturing. But there has been no systematic review of the functions of state government by outside experts since Linwood Holton was inaugurated 23 years ago.
What's needed is a large management consulting firm with a track record advising America's largest corporations.
\ Medicaid: It's an oft-told tale that the cost of providing medical care for the indigent under this federal-state program is swallowing everything in sight. In fact, more than half the new money that Gov. Wilder proposes to add to the state's 1993-94 budget is earmarked for Medicaid.
There are two approaches to cost containment under Medicaid that might offer hope. The first would be to copy the original idea of Britain's National Health to enroll all patients with a primary-care physician on an annual-fee basis, whether the physician sees them frequently or not at all. But Americans wouldn't accept that.
One variation might be for the state to contract with individual physicians, or the proliferating outpatient clinics operated by hospitals, to take so many Medicaid patients by name on their permanent register. They would offer primary care and make referrals to specialists as required. Advantages of such a system would include continuity of care under a single provider and less opportunity for abuse.
For Virginia to implement a contract system for primary care under Medicaid, which ought to be tried first in one of our large cities, it would have to get a waiver from the federal government. The hope for this is not auspicious, as Oregon's recent experience in trying to change the system would testify. But William J. Clinton was for 12 years a governor who wrestled with awesome increases in the cost of this program, and he has made various statements indicating an openness to fundamental reform.
\ Welfare: It is by now clear that the Great Society goal of ending poverty and social unrest through welfare has not worked as intended. One measure of the social disintegration that has taken place in this country since Lyndon Johnson's mandate in 1964 us the homicide rate in the city of Richmond. In 1964, there were 34 murders in a city of 222,000. In 1992, there were 120 murders in a city of 200,000.
The present welfare system perpetuates itself by erecting every possible impediment to lawful, gainful employment. It would be relatively simple to devise a system that encourages a transition from full reliance on welfare to partial reliance, or none at all. Again, federal cooperation will be required, but Clinton has proclaimed himself the president of change.
\ Prisons: When Holton took office, there were about 8,000 inmates. While the state's population has grown by 25 percent, the prison population has grown by more than 100 percent, and the Department of Corrections is predicting 30,000 state prisoners by the year 2000. At present costs, that will mean an additional capital outlay of $700 million and annual operating expenses of more than $600 million.
If the idea of prisons rehabilitating criminals has been pretty thoroughly discredited - as I believe it has - we ought to look toward a system that keeps certain categories of offenders for less but harder time, with less rigmarole about parole and work release.
For those who must be incarcerated longer, we have never done more than scratch the surface of what could be done to make more efficient use of prison labor producing goods and services for both government and the private sector. By raising prison wages to more equitable levels - and by mandating that a portion be set aside against the day of release - we could probably accomplish more than all the counselors and therapists could ever do. That is, a prisoner released with a job skill and a few thousand in his jeans will have a better chance of not coming back than one turned out with nothing.
While this is only a short list of possible new initiatives, and leaves education out entirely, now is a time when we must be prepared to think and act anew. Or resign ourselves to the cost of government rising faster than our personal incomes.
Ray L. Garland is a Roanoke Times & World-News columnist.