The Unloved Foster Child: Health and Human Services in the Tea Party Era
Every state has one. The federal government funds at least half of each of them. They gobble up 40% of the average state budget at a minimum. $17 trillion has been spent nationally on their services since they were first instituted in the 1960s – a figure equivalent to today’s national debt.
They are: the Departments of Health and Human Services. H-H-S.
You know, that smudgy building downtown, somewhere near the DMV and the county jail. The place where the people going in and out all seem to be overweight. The offices where every occupant, both in front of and behind their thick glass service windows, are in dire need of a shot of serotonin. The weary, scorched battlefield of the pyrrhic war on poverty.
Among the top five “big states,” Texas is third in its HHS spending by dollars, which most recently was just under $80 billion for our state’s 2-year budget (by contrast, the nation’s biggest HHS spender, California, spends over $90 billion per year!). Per capita spending in Texas is at a considerably lower rate, however, and more on par with a medium-sized state. Still, if one were to separate higher education from regular schools within the education allotment, HHS spending would be by far the single largest spending category in Texas and virtually all other states.
But these humongous numbers don’t tell the full story of HHS spending. Its programs have become a part of many Americans’ daily lives. HHS spending in Texas encompasses pretty much anything with a health or well-being nexus: foster care support, restaurant inspectors, public health workers (like those who tackled ebola in Dallas last fall), addiction treatment for the indigent and schools for the deaf and blind.
And all of these services pale in comparison, fiscally, to the entitlement programs. Nationally, 1 in 5 children are on food stamps. More breathtaking, 1 in 5 of all AMERICANS are enrolled in Medicaid – the joint state-federal health insurance program for the poor. In Texas, even in the absence of its expansion under Obamacare, Medicaid enrollment registers a 5% increase annually (in states with the expansion, the annual enrollment rate is a staggering 20% or higher).
The nature of HHS spending, however, is self-feeding. If you are low in it, that doesn’t necessarily mean everything’s hunky-dory. Texas, for instance, happens to have the ignominious distinction of ranking dead last by state in people with any type of health insurance. This means more ER visits, which ultimately result in higher per-episode of care Medicaid charges by hospitals, along with more cost-shifting and higher private insurance premiums for the rest of us. Reductions in mental health treatment ALWAYS translate into an exponential increase in law enforcement and corrections spending.
HHS spending is the overweight, abandoned child that no one knows what to do with. It is so unhappy that most of us can only think to keep taking it out for ice cream. We tend to do this because we think it’s not our child to discipline, we want to be liked and thought of as caring, and we’re just bewildered by its needs.
Others, however, want quietly to go to the other extreme, thinking the best discipline would be to starve the child, even to death. These people know the child isn’t theirs and want it out on the street, believing that such treatment will motivate it properly to become a good, productive citizen. This is the overwhelming sentiment of most TEA Partiers, and some public officials have even begun to say this outright.
But even for the most empathetic conservatives as well as some Democrats, it is obvious that HHS spending, public assistance – whatever - at all government levels will soon swamp the boat. Obamacare will only hasten the fiscal apocalypse. For decades, the prevailing Republican strategy of dealing with this spending category has been twofold: rejigger reimbursement and benefit formulas such that less money goes out per instance of use (the most recent example of this is SNAP in the 2014 Farm bill), and generally cut taxes thereby starving the beast through the back door. In this manner, the more conscientious Republicans can say they’re not singling out anyone with cuts, be they a doctor or an inner city single mom, but are instead simply being fiscally prudent.
Additionally feeble are the rhetorical calls to stop “waste, fraud and abuse” in HHS programs, but zero effectiveness against these three little piggies has ever been achieved for various reasons. In many instances, illicit use has gotten worse at both the state and federal levels. In Texas, the whole effort has recently become engulfed in scandal. Today, now that many state legislatures have become controlled by hardcore TEA Partiers (and Congress to a certain extent) there is no other fiscal strategy BUT to put these programs on a permanent cleanse diet. This is a big part of the mantra to repeal Obamacare. TEA Partiers have broken the emergency glass on social spending, and they insist that “liberty” will ride to the rescue if only government is removed.
So what can save the fat kid, if we are to depend on freedom? The terse answer from hyper-idealistic conservatives has always been – now it’s only louder – “the church” and likely charities by extension.
Let’s consider this for a second.
Taking Texas as a good big-state example, there are roughly 14.5 million residents identified as churchgoers according to Gallup research. This means that to cover one year of the state’s HHS spending, each and every one of these churchgoers would need to give about $1380 annually, on top of what they are already tithing, assuming they are tithing (most studies reveal that only 5% of churchgoers actually give a full ten percent off a paycheck).
Hardcore conservatives insist something like this is doable if taxes were cut. Well, the per capita sales tax collected from a Texan is about $1100. If we eliminated the sales tax entirely, churchgoers would still be more than $250 short for their annual contribution, just for public assistance. Then, you would have to come up with some sort of coordinated distribution system, as some churches would collect an abundance while others would take up practically nothing. Then the benevolence committees would have to administer all the help based on need. Humans being human, this is fraught with pitfalls, even among the most righteous. In the case of eliminating Medicaid, would we presumably be paying someone’s insurance premium they bought off an unsubsidized Healthcare.gov? Maybe my local county Baptist Association could handle it; maybe not. This is only the beginning of SOME of the questions about how help would actually be delivered.
Sound realistic? More fundamental to caring for the unloved foster child is why have government do it all? Liberals and secular utopians have relied on government’s involvement because they hold dearly to the principle of coercion in order to improve people’s health and cure society’s ills. This of course has never worked in America, as even the laziest scammer is eager to assert their “rights” (or understanding of them) when pulling off the dole. Hence, our looming fiscal crisis.
Republicans have generally gone along with government-led assistance because, in all practically, it has been the only way to deliver large-scale relief. This realistic principle remains true today, and I know that TEA partiers don’t want to hear it, if for no other reason than that they are trying to protect their own Medicare and Social Security from those they deem sub-American.
Sensible people, even conservative Christians, know that HHS spending is a duty of sorts. The true questions should be asked about the BEST way to administer it with a focus on outcomes, both fiscally and with an eye toward empowering the impoverished.
A recent study by the Vera Institute, found that the number of people being held in the nation’s jails has tripled in the past 30 years, even as the crime rate has dropped significantly. The study found that the vast majority of these individuals are being held for minor offenses, and they’re stuck there because they’re too broke to post bail and pay court fees. At the same time, these offenders have not insignificant mental health issues and the addictions that go with them.
It’s true we shouldn’t buy the struggling child any more ice cream. It’s also true that we should be smarter and more confident about figuring out what he needs, and we shouldn’t be afraid to let government acquire and administer the smarter resources. It’s true – ultimately, the kid does need liberty – but only real, spiritual freedom can love the child. This is what should be at the center of any material relief. This is, in fact, what it means when the Bible says “the gospel has been preached to the poor” as part of the Messiah’s ministry of healing.
A big part of why HHS spending is failing is the same reason our public schools are awash with moral chaos: no God-fearing center.
Again, here in Texas, our massive Health and Human Services Commission has just undergone a major review as part of the Sunset law. The Sunset Advisory Commission made several thoughtful recommendations for improving the massive agency. This is just a start. True care for the needy must convey spiritual healing. Our same calling to preach should also be the underpinning of our duty to give public help.