After putting it at the bottom of my stack of books to read for over a year, I recently began reading Edmund Morris' wonderful biography, The Rise of Theodore Roosevelt. Once I'd actually turned a few pages, it was hard to put down. Not the least of its pleasures for a contemporary liberal Democrat is the recognition that T.R., a maverick Republican, was warning us 100 years ago about the "unnatural alliance of politics and corporations."
For a reformer like T.R., the corporate poachers of his day were focused on securing government contracts for military procurement, utility franchises, railroad easements and other blatant examples of picking the public pocket. In New Mexico (and in all 50 of the states) in 2004, it appears that yet another trough has been creatively filled for the delectation of our corporate piggies: the management of governmentally-financed programs.
"What worried Roosevelt was the inability of ordinary people to see the danger of this proliferation of cogs and cylinders and coins in American life," writes Morris. "The corrupt power of corporations was increasing at an alarming rate. ...What chance did women, children, cowboys and immigrants have in a world governed by machinery?"
Today's industrial pirates are perhaps more sophisticated than their ancestors at the start of the 20th century, but every bit as dangerous. With electronic technology at their beck and call, they are able to operate well beyond the glare of public oversight.
And unfortunately, many of the very government officials who are positioned to blow the whistle on the worst of the gluttony seem to feel their jobs are quite the opposite: making sure nothing disturbs the rapid consumption of public monies by ravenous private sector trough lickers.
This is not a partisan matter. The doors to the feedbins have been thrown open as widely by Democrats as by Republicans. What it stems from is the cynical, almost universal, attitude that government simply cannot function without the supportive help of an army of private sector consultants, technical assistance organizations and even surrogate employees.
T.R. would be livid.
In our current climate, it isn't surprising to hear that, incredibly, New Mexico's new behavioral health program is going to be contracted out to the private sector. Instead of simply pooling the available money and providing services, the state intends to develop purchasing collaboratives based on private managed care principles, but with lots of taxpayer gravy to be lapped up.
Excuse me? Behavioral health managed care? Are we serious? Are we nuts?
What's the harm in contracting out this state's mental health and substance abuse services as managed care? For starters, it comes with built-in incentives to entice "reluctant" corporate suitors, which then allows private industry to skim the system of the guaranteed millions in profit margin (extra money not really needed to provide services, I guess).
Duh. As we've had so pathetically demonstrated to us over the past 10 years with the conversion of regular health care into the managed care model, the entire financial equation shifts; profit drives the provision of care, not the patient's needs.
It's like saying, "Yeah, sure, the Hippocratic oath and all that, but dang it, Doc, your productivity has slipped this quarter so we've decided that if you don't turn things around and generate a bigger profit for us, we'll have to drop your contract and make do with three nurses and a CPA instead."
It doesn't take a mind reader to foresee the potential disasters that litter the roadway ahead. Let's be clear. Managed care companies make more money by saying “no” to requests for service than by saying “yes.” In physical health situations the sufficient countervailing force to this HMO inertia is the possibility that saying no could lead to worsening symptoms requiring more expensive treatment down the line such as hospitalizations, surgeries or even deaths.
In behavioral health, that particular brake on the pressure of corporate greed doesn't exist. Skimping on counseling, substituting less-expensive medications, and refusing treatment or hospitalizations are likely to wind up hurting the managed care company's bottom line by requiring something more expensive to be done in a few months.
What will result is that a few more edgy, nervous outpatients, a few more not-quite-detoxed junkies and a few more anxious, depressed clients are out on the street.
Of course, wasn't that the whole idea behind community Mental Health? We would all benefit from treating the disorders of the addicted and the mentally ill; saying “no” to treatment shouldn't be rewarded. There are way too few financial resources available for behavioral health in this state as it is to waste them on systems of care managed by companies motivated by profit.
I don't know if it is too late for New Mexico to rethink this plan, but it should.
The clink of the slops jar on the metal edge of the trough brought the private sector running. Their appetite is huge.
The opinions expressed are solely those of the writer. Email firstname.lastname@example.org