I've been contemplating two old saws: "The buck stops here" and "passing the buck." And thinking about how these apparently contradictory sayings can be applied to the Utah Legislature with relative ease.
Over the past couple of years, lawmakers have proven that "the buck stops here" by mandating massive cuts in a variety of programs. For instance, before July 1, Rod Betit of the Division of Health Care Financing, which administers Medicaid, is supposed to come up with $13 million worth of reductions in existing programs. People being served by the programs he is cutting back or eliminating are not amused. Neither is he, for that matter.At the same time, the Legislature has "passed the buck" by leaving the individual divisions affected to make the unpopular cuts and take the wrath of those who are adversely affected. Worse, they have on occasion passed laws, then refused to provide funding to carry out those laws.
Sanity examinations and competency evaluations are a prime example. Salt Lake County commissioners recently announced they would no longer bear the burden of paying for the exams - or carry the cost of housing those committed to the state hospital in other facilities until there's room for them. They encourage other counties to refuse, too. It is a state responsibility, by law, they have said. And they are right - in a way.
The Legislature acknowledged that paying for both the exams and the temporary placement should fall to the state. So they passed a law about it - a law that may go down in history as the ultimate example of wishy-washiness. What it says, basically, is that the state is responsible for the cost as long as the Legislature allocates money for it. If it doesn't, who knows what is supposed to happen?
You guessed the next part. The lawmakers didn't designate funding, and now the state and the county are about to thumb-wrestle for it. Keith Stroud, director of the Division of Mental Health, openly says he feels responsibility for the payments belongs to the state. But if there's no money . . .
During the past couple of weeks, the Health Department - and particularly the Division of Health Care Financing - has come under fire for a proposal that would alter the method of paying for inpatient psychiatric care of Medicaid patients at urban hospitals. The division wants to adopt a Diagnostic Related Group system, where payment is based on what category your illness seems to fit best, and the allowable days for treatment. Under that "averaging" system, payment for services for anyone who fell in a particular category would be the same, regardless of whether actual treatment took two or 12 days. (There are exceptions, but they're not relevant here.)
What is relevant is this: Any time a budget is cut, no matter how carefully, there are people who are upset. Medicaid eliminated payment for adult dental treatment, and it was tragic. And even unfair. But it happened. And screaming at the Medicaid administrators about it won't change the bottom line financially. If adult dental care is restored, something else will have to go. And that will upset a whole new set of people. Screaming at the Legislature might make a little more sense; they do control the purse strings. But if there's no money, what can they do?
The sad fact is there are no good cuts when you're dealing with human lives. Families of the adult mentally ill population have good reason to be upset. I know that I could take the entire state budget, allocate it to social service programs, and still not meet all the human needs.
But one fact should always be remembered: Rod Betit is not sitting in his office saying, "I think it's a slow day. Guess I'll whack $13.5 million out of very necessary programs." He'd like to be the Guy in the White Hat and provide complete funding for all of the programs that are Medicaid options. Just like Keith Stroud would like to see the state pay for the evaluations.
During talk of a tax reform initiative, I frequently heard the complaint that reformers have, unfairly, called for cuts but refused to specify where they should be taken. I think that's a valid criticism.
It isn't right for tax protesters to look at the state budget from a safe, fact-ignorant distance and say "get rid of X number of dollars" without knowing whether or not cuts can be made without doing irreparable harm.
Any more than it's right for lawmakers to do it. Or to design programs and not fund them. But if the Legislature's going to tie someone's hands and then demand he clap to the music, then those same lawmakers ought to take responsibility for it. Instead of passing the buck, while keeping the buck.