Delaware’s Department of Correction is under Federal court order to fix a broken prison health care system. The alleged wonders of privatization have once again been exposed for what they are–private profit at taxpayers’ (and consumers’) expense.
The proposed solution? Break down the large failed bureaucracy into ten smaller bureaucracies, according to today’s News-Journal:
Rather than having a single health care provider, prison officials are breaking the contract into 10 smaller agreements focusing on specific services. The change comes a month after Corrections Commissioner Carl C. Danberg announced he was ending a contract next year with St. Louis-based Correction Medical Services (CMS), which has been criticized for providing inadequate health care despite being paid more than $130 million over three years.
Allow us to journey once again into the language of the bureaucrat, this time, DOC Commissioner Carl Danberg:
“We expect this flexibility, and the increased competition it is expected to provide, will foster improved medical care and cost savings,” Danberg said. “The Department spent significant time exploring alternative solutions to the way we contract for medical services. We believe this alternative will allow for large and small service providers to bid on the areas that fall within their specialization.”
So far so good. As we delve deeper into the article, however, it appears that such expectations bolded above are more dependent on faith than on actual, you know, data:
Danberg has said he is not sure if the new contract format would reduce costs, adding that results he’s seen across the country are mixed. While more companies competing for more bids would likely be financially better for the state in the short run, managing a larger number of vendors could become a problem as it increases other costs, such as hiring more people to oversee vendors.
Bottom line: This is what we know and what we do not know. Either this will reduce costs or it won’t. Either this will provide improved medical care or it won’t. That much seems clear.
Believe me, I’m not here to diss Carl Danberg. He seems to be Delaware’s best ‘go-to’ guy when it comes to, as Donald Regan put it, “cleaning up after the elephants.”
He inherited this mess, and he’s doing the best he can.
However, I’d like to ask just a few questions that might clarify whether this proposed cure is better than the disease it seeks to remedy.
1. How can 10 mini-bureaucracies be more efficient than one large bureaucracy? Has this model empirically worked anywhere, especially when it comes to health care delivery?
2. An effective and efficient health care delivery system would seem to depend on superior coordination amongst its many branches. How is this even possible with 10 different contractors working their own individual mini-bureaucracies? Who will be the ‘grown-up’ in this equation?
3. Doesn’t a splintered system like this, by its very nature, lend itself to ‘passing the buck’? As in, that’s not our responsibility that’s fill-in-the-blank’s responsibility. Multiply by 10, and you get what I’m gettin’ at.
4. Why in hell should Corrections Medical Services (CMS) be allowed to bid on any element of this contract? Their misfeasance and malfeasance is the principal reason that the State is under court order to clean up this mess.
None of these questions were answered in the article. While I fully recognize that the State is under extraordinary pressure to do something, absent any empirical support that this plan might work, why is it even being considered?
A couple of final points. Yes, prison health care would be much better if the prison population was reduced, as was suggested by an expert quoted in the article. And I think that the judiciary has finally challenged the notion of mandatory sentences for non-violent offenders to the point where reform is in the offing. However, profit-driven enterprises providing contractual services previously done by state employees will invariably seek to maximize profits by providing as little care as they can get away with. Just like CMS did.
Which is why I’d like to see the state do a cost-benefits analysis to see whether it makes sense to restore these responsibilities to state employees and do away with these private contractors. States all over this country were sold a bill of goods on the wonders of privatization. Hindsight being 20-20, it’s no surprise that the privatization advocates snowing the General Assembly turned out to be the blind leading the blind.