Tackling Georgia’s problems with health care must be a top priority of our next governor. So why did the current governor this past week veto a bill intended to bring experts together to craft solutions to those problems?
In short, the bill added complexity and bureaucracy to a system already plagued by those ills.
Senate Bill 357 was the chief product of the Health Care Reform Task Force the Senate convened in 2017. The idea, as stated in the bill, was to create a “state-wide coordinating platform” that would “unite the major stakeholders and components at all levels of the state's health system.”
Here’s what that meant in practice: first, the creation of an 18-member Health Coordination and Innovation Council comprising eight existing state agency heads, the attorney general, six gubernatorial appointees and two legislative appointees. The 18th member would be a new “Director of Health Care Policy and Strategic Planning,” tapped by the governor and authorized to hire “such other professional, technical and clerical personnel as deemed necessary.”
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There would also be an advisory board to the council with between 13 and 19 members, all appointed by the governor. Finally, more than a dozen current boards, agencies and commissions would report their work not to the General Assembly but to the newly created council.
For those keeping score at home, that’s as many as 26 new gubernatorial appointments, not including the five agency heads who already are selected by the governor; plus at least one new state employee and likely several others; as well as a significant shift in oversight from the Legislature to the executive branch.
The polite term for all this is “streamlining.” A less generous description would be “centralizing power” and “growing government.”
So many problems with our health-care system stem from putting too much authority in the hands of too few. Anyone who recognizes that must view SB 357 with deep skepticism. As should anyone who knows the value of such appointments often accrues more to the persons making and receiving them, rather than to the citizens and taxpayers. Indeed, Gov. Nathan Deal explained his veto by saying the bill, “while well-intentioned, creates several unnecessary additional levels of government.”
There’s also reason to doubt the bill’s premise that government must not only coordinate health care itself within the state but innovation as well. That is exactly backward. In fact, there’s already a great deal of health-care innovation in Georgia.
Companies large and small, rural and urban, are improving their employees’ health and their bottom line by experimenting with the ways they pay for and, in the case of on-site clinics and pharmacies, even provide care. The state needs to learn from them. But that doesn’t require a new council, board and sure-to-grow agency.
There is a place for a more limited group to review how state government can be more efficient in providing access to employees as well as those on safety-net programs such as Medicaid. There’s even a blueprint for such a group: the Criminal Justice Reform Council. That council, also created by statute, includes 15 members chosen by the governor, more than half of whom are already elected or appointed officials. But it doesn’t require a separate board to advise it, nor a new director and additional support personnel. And while it can request data and records from state agencies, it doesn’t shift their reporting duties — and thus much of their oversight — away from the Legislature. Its only real power is to recommend legislation to the General Assembly. That’s the model for the next governor to follow when it comes to improving health care.
Kyle Wingfield is president and CEO of the Georgia Public Policy Foundation: www.georgiapolicy.org.