Kansas is bringing in three national insurance companies to run services for people with developmental disabilities in that state. It’s the first time any state has ever applied this model to its DD services and it bears watching. It has all the hallmarks of the ongoing debates about privatization vs. public, non-profit services and could have huge ramifications for people with developmental disabilities and their families across the country.
The data so far in the broader experiments with privatization have been mixed. Services such as transportation, infrastructure, food services, facility maintenance and things like that have done pretty well. Things like health care, education, direct care, criminal justice and quality control have had more problems.
The basic tension is clear and quite simple. Services and supports that we as a society have determined should have a similar level of quality for everyone and be available to all who need it don’t respond as well to a purely profit driven model. In other words, we have already decided that things like health care and education are not choice driven. We want those who need health care to have it. Look at the hospital emergency room situation. In most cases people are not turned away because they can’t pay. And a free and appropriate education for all is a long standing mantra for our society.
The questions then become centered on what is the best way to structure and pay for those and other public services seen as necessities—safety, justice, voting, etc.
Supports and services for people with developmental disabilities still fall within a grey area here, even after all these years. The public by and large supports a comprehensive network of supports and services for people with developmental disabilities in the abstract. When those get more specific in terms of where those supports and services will take place, how much it will cost and who is going to foot the bill, that public backing can become less solid.
People with developmental disabilities and their families don’t want to be lumped into the health care system, any more or less than the rest of us. A developmental disability is not an illness. But they often need help. Many of them and their colleagues would like to see those supports and services more embedded with those that are considered the ones we currently consider entitlements for those who are eligible. Many people with developmental disabilities already qualify for Medicaid entitlements but that is, of course, a health care based system and has a number of biases and complications that must be worked through and around to universally apply to the kinds of community based situations that have become the most accepted by those who need them.
There is a strong case to be made there. It is clear to most anyone hearing the stories of children and adults with serious disabilities that it is in the best interest of a society—morally, economically and practically—to have systems in place to promote the best outcomes for them and, consequentially, their families.
In the words of George Bailey (“It’s A Wonderful Life” in keeping with the season), “Doesn’t it make them better citizens? Doesn’t it make them better customers?”
Which brings us back to Kansas.
An article in Hutch News lays out some of the problems with taking the public-private hybrids, like New Jersey’s, that have been the most recent incarnation of the search for the right balance of market and government, to the final step of taking government out of it completely.
That may be a mistake.
Government and private industry must, by their very natures, function differently, for good and ill. Public services must take place under the magnifying glass. The public will demand it and rightfully so. Private businesses must have some protected autonomy. I believe the whole public-private partnership, which has had some great successes, as well as some notable failures, has these inherent tensions. When you go too far toward one model or the other you begin to risk dangerous imbalances. Too much regulation stifling a business’s market competitiveness and innovation. Too little oversight of programs and services for the purpose of caring for some of society’s most vulnerable and challenging citizens. On the one hand you might have a situation where the city, county, state or country’s economic engine might be more sluggish. In the other though you have people’s welfare and very lives dependent on the outcomes.
The Kansas experiment bears watching over the course of its trial run. It is the kind of thing that can look good for a while and then go seriously off the rails when no one is paying attention anymore. Or it may offer a whole new better way to manage services for people with developmental disabilities.
What do you think?