All politics and all health care reform is local

Here at the Forum we try to keep our work current, focusing on topical issues of importance. Health care reform is obviously one such issue. Yet the Forum's mission is to inform local policy debates, not national ones. So it was not immediately apparent what role we might have to play in the conversation about health care reform.

An article in last month's Governing Magazine made it more clear--local policy decisions can have big impacts on health care costs and on the health care system itself. The Governing article was actually about state budget decisions; it seems many states are cutting their support for poison control centers, which some studies have shown save big money in emergency treatment costs.

The author of the article (none other than Don Kettl, namesake of the Kettl Commission on state-local partnerships) notes that "most of the political and budgetary pressures we face are pulling policymakers away" from investment in system efficiencies and preventative medicine, and are instead resulting in "strategies that might save a few dollars now but drive up health costs in the long run."

As we digest the proposed 2010 City and County budgets, we should keep in mind that there may be long-term ramifications of budget cuts that will reverberate beyond Milwaukee. The proposed budget for the city's Health Department, for example, includes an 8% reduction in expenditures and an 11% reduction in staff compared to the 2009 adopted budget. Cuts in state and federal revenues result in a county budget that calls for a 9% reduction in expenditures in adult community mental health services and a 7% cut in expenditures for AODA services (drug and alcohol treatment) compared to 2009--leaving holes that are difficult to fill with local revenues.

These cuts may in fact reflect new efficiencies and may not negatively affect services or outcomes. Or, they may be penny-wise and pound-foolish from a taxpayer's point of view, saving money today that will create a debt later. Citizens need to be aware of the potential for either outcome and judge proposed budgets accordingly. The Forum will try to help; look for our detailed city and county budget analyses in mid-October.