We read with interest the opinion of former Department of Health secretaries Ed Feaver and Bob Williams on the proposed consolidation of Florida's five health and human service agencies. We applaud them for their past service, but must strenuously disagree with both their assertions and the basis upon which they drew their conclusions.
Gov. Rick Scott has it right. Florida needs to challenge the existing bureaucracy and ask the tough questions. And that's what the governor's transition team did.
By their own admission, these former secretaries believe that what is wrong with these multiple agencies is that Florida's "limited government political philosophy" has "weakened these mission-focused agencies" and that "agency funding has not kept pace with their needs." With all due respect, the argument that government is not big enough, and that we should be spending even more money, couldn't be more disconnected from the reality Florida faces.
To be clear, Gov. Scott's transition team did not propose re-creating the old Department of Health and Rehabilitative Services, which we agree was a failure. In fact, the team was careful to propose keeping the state's child welfare programs separate. Anyone who remembers HRS will recall the primary difficulties faced then were failures in the child welfare system.
In fact, since the days of HRS, much has changed. Back then, the state was the primary provider of services for people with disabilities and the elderly. The state was the primary provider of services for children in the child welfare system and the foster care system. The state was operating a health care cost containment board, and virtually no hospital expansion or construction was permitted to happen without a certificate of need. These examples of how large and unwieldy the bureaucracy was are good examples of why the agencies were separated.
Today, the environment is totally different, and the state has evolved. Most services for people with disabilities are provided by private entities. The child welfare system has been reformed, and now most child welfare and foster care services in the state are private, community-based agencies. Certificate of need has been dramatically reduced in scope. Many of the 14 different waiver service programs funded by the state are literally operated by multiple agencies with significant overlap — in some cases three agencies are operating the same waiver program.
Why would we have two different health agencies investigating bad clinical outcomes by providers, when in many cases, the bad outcome was systemic and crosses these provider types? And why are some child health services managed and overseen by three different agencies?
So, the suggestion that consolidation of agencies that already share responsibility for various functions would result in the same fate as HRS is simply wrong. Consolidation would better align several agencies with similar functions.
Finally, the advocates for larger government suggest that one of the Department of Health's most important functions is to "improve the health of Floridians." That seems to conflict with the law, which actually makes the Agency for Health Care Administration (yet another state health agency) the chief health policy and planning agency. This type of "mission creep" is not unusual in a government bureaucracy that isn't regularly challenged.
Reasonable people can disagree about the scope of the mission of the Department of Health, but all would agree the primary mission is to prevent the spread of disease, protect us during a biological or natural disaster, be a provider of last resort in underserved communities, and provide data and information on public health. We would argue better health correlates with better economic conditions and less poverty — not necessarily a larger government bureaucracy.