Gary and I have a bit of grit in the gears of our now going on decade long friendship and I’m afraid I’m the one who caused the problem.
Sometimes, if it’s a good story about how government works (or doesn’t work), I write about what I see or learn while working with a client – and I’ve learned a lot of great stories about Governor Perdue’s Department of Health and Human Services foibles (like granting no bid contracts to former lobbyist and now Secretary Lanier Cansler’s clients) while working with my friends the Hospice and the Home Care folks. The rub is, occasionally, when I write one of those stories it irritates Gary’s friends the Rest Homes folks – which is natural as the two groups are fierce competitors.
I expect at times that’s caused Gary a problem but he’s been too courteous to complain. In fact, he’s hardly ever mentioned it. But, at last, the other day he did write an article responding which was, by the way, a paradigm of the kind of politeness that only comes with age and wisdom and which to my way of thinking is a rare sign there is such a thing as human ‘progress’ – after all, not too many years ago when Gary and I had a disagreement the next step would have been to pull out the blunderbusses and have at it (in the form of negative TV ads) with no courtesy at all.
So first, Gary, let me say if anything I’ve written has caused you any inconvenience at all – I apologize.
Second, I apologize again – because I’m about to do it again.
At my age there’s just about only one temptation I can no longer resist: A good story. I’m no admirer of Governor Jim Hunt but that’s why I read Gary’s biography of Hunt straight through in three sittings. It’s a riveting story. And, in that same vein, the story below is just too good to resist telling – so here goes:
The gray eminences at the Department of Health and Human Services had a problem: After closing a good part of the state’s mental hospitals and then bungling how to set up a new regimen to care for impoverished mental patients they had no place – or not enough places – to care for the mentally ill. How DHHS solved their problem was straightforward: They shuffled six thousand schizophrenics and other mental patients on Medicaid into Rest Homes – which were meant to care for the elderly. And which, I’m suspecting, was a shock to Rest Home owners who had their hands full already.
The result was a first-class catastrophe and after four murders, where violent mental patients killed other patients in Rest Homes, Disability Rights (a non-profit group that advocates for the mentally ill) had had enough: It called on President Obama’s Justice Department to investigate and the President is obliging – the Justice Department’s about to investigate Governor Perdue’s warehousing mental patients in Rest Homes.
Now you’d think the folks who run Rest Homes would be tickled to death to get out of the business of caring for the mentally ill – which they never meant to get into in the first place.
But, you’d be dead wrong.
The way Rest Home folks saw it Disability Rights hadn’t just attacked Governor Perdue –it had attacked them. So they fired a broadside of their own right back saying if the do-gooders really gave a toot about mental patients, instead of trying to turn them out of Rest Homes they’d get the state to pay the Rest Homes more money to care for them properly.
Now maybe that did or maybe it didn’t make sense.
But there was a second surprise in the Rest Home folks broadside: The way they saw it Disability Rights calling on Obama’s Justice Department to investigate them was a sure sign there was sinister conspiracy was afoot between their arch-competitors the In-Home Care folks and the do-gooders.
Now if an elderly aunt or grandmother can’t, say, bathe herself or go to the bathroom on her own and if she’s on Medicaid in North Carolina she has choices: She can apply for part-time care in her own home. Or she can apply to go into a Rest Home.
The Rest Home folks studied the Disability Rights complaint, added one plus one, came up with a conspiracy, and, then, when they blasted Disability Rights ripped into the Home Care folks too – who’ve never even dreamed of caring for schizophrenics.
Right quickly the Rest Home folks let fly with a haymaker saying that on average the In-Home Care folks charge a whopping $6,892 a year to provide 2.6 hours a day of care to folks who can’t bath or go to the bathroom alone while the Rest Home folks provide the exact same services 24 hours a day for a little less money.
Which sure sounded like Rest Homes are a great deal compared to In-Home Care.
Except there’s a fact twist in their math – or, rather, a fact omission.
What’s called ‘personal care’ for elderly patients – say, for bathing – costs the government about the same whether the care’s provided in a patient’s home or in a Rest Home. But there’s one big difference: If a Medicaid patient goes into a Rest Home the government also pays for his food and housing and heat and air-conditioning and electricity and the bed he sleeps in – all of which the patient pays for himself (or herself) if he stays at home. In fact, in North Carolina the government’s made it easier for a Medicaid patient to get full-time care in a Rest Home than part-time care in their own home.
So treating a patient in his own home costs the state a lot less than it costs to treat the same patient in a Rest Home ($22,457) which is why most states, with the odd exception of North Carolina, prefer to care for patients in their own homes.
Now, what’s the moral of this story? Consider the facts: The state shutters mental hospitals, has no place to care for patients, ships them into Rest Homes (which were never meant to care for them), the do-gooders object and the Rest Home folks – faced with the prospect of losing six thousand paying patients – roar bloody murder and declare the real answer is to pay them more money.
Here’s the point: It turns out treating mental illness is a near-perfect metaphor for how government works.
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