Health agency is no rose garden

By Scott Mooneyham | Sep 19, 2013

RALEIGH -- Lately I've been wondering whether that old tune, "I Never Promised You a Rose Garden," is running through Gov. Pat McCrory's head.

After all, the sun is not shining in two places, and there is more than a little rain falling, especially at the state's health agency, the Department of Health and Human Services.

The agency has always had its problems.

The reason is pretty simple: Its total budget, when accounting for federal Medicaid money, is $20 billion, roughly the same amount as the entire state general operating budget that goes to run schools, universities, prisons and other state functions.

The Medicaid budget alone is more than $14 billion when that federal money is thrown in.

McCrory came into office appearing to understand challenges posed by the department and its gargantuan Medicaid program.

At a news conference where he introduced his agency head, Aldona Wos, the first question that I asked was whether he worried that a new Medicaid claims system scheduled to go online July 1 might be unable to deliver.

The cost overruns and delays that had plagued the computer system were no secret. They had been the subject of critical state audits.

Other controversies involving the department -- whether overpayments to hospitals or rat hole-like mental health services programs -- were also well-known.

Nine months later, it is less than clear that McCrory, Wos and those around them really understood the task at hand and how to accomplish their aims of a more efficient agency.

Meanwhile, using looser personnel laws to move people in and out of high-paying jobs has created a new set of problems, threatening the credibility of agency decision-making.

So, doctors and hospitals have been left to negotiate a Medicaid payment system beset with delays and confusion.

And increased personnel flexibility advertised as a means to improve professionalism in the department instead seems to have led to a level of cronyism that would make the Democrats who once held power red with embarrassment or green with envy.

McCrory says he would like his agencies to operate like business. Government agencies, though, are not businesses.

They can't declare bankruptcy; they can't decide to scale back and move away from a weak market; they can't turn away customers.

For government, the shareholders and the customers are one and the same. Politicians who lose sight of that difference do so at their own peril.

By all accounts, Wos is dedicated and hard-working. What she is not is an experienced, government administrator.

If she were, she might recognize that no top administrator in a bureaucracy as large as DHHS could ever hope to change course without the cooperation of the mid-level managers.

Replacing those mid-level managers with people who have no experience running complex government health care programs won't work. Neither will turning the remaining managers against you.

DHHS is no rose garden.

It never was and never will be.