The Meaning of Deregulation

Transcription

1 T The Meaning of Deregulation EDITORIAL &5 HE current assault on government health regulations is ' part of an overall attempt to restore the laissez-faire ' l 1 economy of the nineteenth century. It is based on the theory that the troubles of our faltering economy and society are the result of government interference; remove government regulation and the economy will prosper. Public health workers who are familiar with recent American history will recall the Harding, Coolidge, and Hoover Administrations, during which the laissez-faire philosophy attained a previous apotheosis, and which ended in the most devastating economic collapse in the history of the nation. They will also remember that public health in the United States, which had scored significant victories in the more progressive cities and states in the early decades of this century, did not come of age in the nation as a whole until the period of the New Deal; more specifically, until 1935, when Titles V and VI of the Social Security Act provided federal aid for approved state maternal and child health and public health programs. It was federal regulations, adopted in 1939, that mandated merit systems for state and local health departments. This was essential because, as the official federal statement on Title VI declared: "In the past the orderly development and maintenance of efficient State and local health organizations has been hampered in many instances by lack of adequately trained personnel and by the uncertainty of tenure of office for competent and experienced health department employees. There have been disturbing changes. In some instances, due to political expediency, competent workers have been unceremoniously dismissed, while incompetent individuals have been appointed or retained. Needless to say, such interference with personnel has created an impression that public health work is a semi-permanent activity of dubious value that may be turned off and on like a controlled stream of water. The time is now at hand for removing permanently the hindrance to an enlightened and pro- 3 Palgrave Macmillan is collaborating with JSTOR to digitize, preserve, and extend access to Journal of Public Health Policy

2 4 JOURNAL OF PUBLIC HEALTH POLICY - MARCH 1982 gressive public health viewpoint. In no way can this be better done than by assuring undisturbed tenure of office for competent persons and sufficient training to insur efficient service. The most important single factor in the success of a public health program is the fitness of those to whom the administration of the program is entrusted" (1). We are now witnessing a return to the pre-i939 situation. President Reagan, with the support not only of his own party but of many Democrats in Congress, has succeeded in making the first totally political appointment of a totally unqualified individual-a pediatric surgeon with no training or experience in public health-as Surgeon General of the Public Health Service. Outstanding state health officers are now being summarily discharged by both Democratic and Republican governors because of pressure from the ultra-right, not simply but primarily because they are doing a good job for public health. The half-life of a state health officer has become ominously short: 60% are replaced every two years. According to Dr. Ronald Whorton of the National Public Health Program Reporting System, a mailing list of the fifty state health officers prepared in January 1980 contained only thirty-five of the same names when revised in June 1981 (2). THE NEED FOR FEDERAL STANDARDS Federal standards with respecto the quantity and quality of state and local health programs are essential if the United States is to maintain a minimum level of performance in the nation as a whole. Otherwise many states and localities will be unable to provid effective services, for two basic reasons: (1) the disappearance of federal standards, and (2) the drasticuts in federal aid. The Reagan Administration proposed an immediate 25% reductionamounting to 35 to 40% because of inflation-in federal aid to the states for preventive health programs and other community health services. What the final disposition by Congress will be is still unclear, but one thing is certain, namely, that there will be very severe reductions in federal aid to the states for public health, probably in the range of an overall current reduction in real dollars by one-third, followed by furthereductions in the next three years. Some years ago, the Mayor of New York City reduced the budget of the health department by one-third. Major programs were crippled or completely discontinued, staff morale plummeted, and the New York City Health Department has never recovered from the blow. There can be no doubt that the severe cutbacks in federal aid imposed by the Reaganl

3 EDITORIAL * THE MEANING OF DEREGULATION 5 Administration and its Republican and Democratic supporters will be a death blow, in fact if not in name, to many health programs and many local health departments. Medicare and Medicaid are prime examples of the need for federal health regulations. The runaway costs of these programs are directly related to the federal policy of noninterference with the customary prices and practices of practitioners and institutions. The federal government finally did develop a series of programs to contain costs, including federal regulations, PSROs, health planning agencies, and federal aid for HMOs -all of which are scheduled for decapitation by the Reagan-Stockman budget axe. It is a curious irony that the new Administration, the name of reducing the federal budget, is destroying the very programs which are designed to contain and reduce costs. Even more ironic is the claim of the Reagan Administration that it is making massive cuts in social programs for the health and welfare of the public in order to lift the heavy burden of federal taxation from the American people. What is really happening is that the burden of federal taxation will not only be maintained but increased by a shift from moderate spending for health and human services to massive military expenditures for weapons of death and destruction (3). Health and human services are deteriorating before our very eyes. The states cannot possibly fill the vacuum left by the federal budget cuts; they are already strapped for funds. Many of our cities are close to bankruptcy and cannot provide even the barest minumum of essential services. The Reagan budget and the Reagan health policies are a catastrophe for public health, a major setback to the health of the American people. Their effects will be felt by people of all classes and all ages, who will suffer an increasing burden of unnecessary illness, disability, and death. And it will require many years, perhaps decades, to replace the highly trained and experienced health workers who are now being discharged, and to restructure the essential health programs which are now being decimated. SPECIFIC EXAMPLES The Reagan policy of deregulation and destruction affects almost every area of public health. One of the most glaring examples is the massive reduction in funds for preventive service such as the Centers for Disease Control, the Occupational Safety and Health Administration, and the Environmental Protection Agency. As an editorial in the New York Times has stated: "If President Reagan had his way, the Environmental Protec-

4 6 JOURNAL OF PUBLIC HEALTH POLICY - MARCH 1982 tion Agency will soon be unable to do itsjob. While Congress is increasing the agency's responsibilities, stretching its resources to the limit, the Administration is proposing savage cuts in its personnel and research budgets" (4). Another example is Medicaid. The Administration has called not only for a cap on expenditures but for sweeping changes which would delete coverage for persons eighteen to twenty years old, repeal freedom of choice of provider, permi the imposition of copayments, eliminate all provider reimbursement requirements, permit provisions for statewide services to be waived, and exclude or limit the benefits of nonwelfare recipients. This proposedecimation of the Medicaid program is only one instance of what the New York Times has described in a recent editorial as "The Art of Kicking the Poor." Commenting on the Administration's proposal to let the stateset eligibility and benefit levels for food stamps, the Times stated: "Having thrown 875,000 households off the food stamp rolls and slashed benefits for an additional 1.4 million families, the White House knows it cannot get Congress to take even harsher measures. But it still hopes that what cannot in conscience be done openly might be achieved in 5o less visible jurisdictions. "This ploy has nothing to do with sound administration. If there were no expectation of further depriving the poor, no one would bother with the idea at this point. The aim is to make the food stamp program as unfair and unpopular as the nation's basic welfare system, with vastly different benefits in every jurisdiction. Oregon now gives a welfare family of four $569 per month; Texas gives the same family $140. "But the nation had better recognize what is going on. It is glib, if not cynical, to contend that states and cities can afford to make up for most of the Federal cutbacks. Their Federal aid is being diminished across the board. The most brutal effect of letting state set welfare benefits will be an ugly competition among them to see whether the stingiest can rid themselves of more poor people altogether" (5). The cutback in food stamps is one aspect of a policy which undermines the health of all Americans, both rich and poor-the debasement of federal food and nutrition services. Changes made by the Reagan Administration's Department of Agriculture include, among others: - Curtailment of a program to discipline meat and poultry processing plants that have been cited for sanitation problems.

5 EDITORIAL * THE MEANING OF DEREGULATION 7 - Relaxation of germ-destroying heating requirements for meats processed from tuberculosis-infected hogs. - Cuts in the number of federal meat inspectors. - Reducing the amount of food required for school lunches, and proposing that catsup and pickle relish be counted as vegetables. - Rescinding the rule that prohibits the sale of so-called junk food, such as soda and hard candies, in competition with school lunches. - Decreases in school lunch subsidies for needy children as well as for children who pay full price. The cost of school lunches has risen sharply, 400 schools have dropped the program, and at least 3 million of the 26 million children who had received school lunches are no longer in the program. - Cuts of $45 million in the school breakfast program, $90 million in the pre-school feeding program, $90 million in summer feeding programs, and a planned decrease in the Women, Infants, and Children Supplemental Feeding Program (WIC) of 66%. - A proposed review of the department's Dietary Guidelines, which recommend moderation in the consumption of fat, saturated fat, and cholesterol, and have been strongly opposed by the meat and dairy industries. The department has also decided not to publish a magazine which contains recipes based on these guidelines. (It should be noted that Deputy Agriculture Secretary Richard Lyng was president of the American Meat Institute, and that Assistant Agriculture Secretary McMillan is a former lobbyist for the National Cattlemen's Association.) (6) A particularly instructive but by no means final example of the Administration's deregulation program is the action taken by the National Highway Traffic Safety Administration throwing out the planned requirement that manufacturers put automaticrash protection such as airbags in automobiles. This action drew immediate protest from safety groups and praise from the automobile industry. The Insurance Institute for Highway Safety commented that rescinding the rule will not only lead to great loss of life, but will cause millions of persons to be permanently brain damaged and otherwise crippled, and result in economic losses that will keep rising well beyond the present $20-billion-a-year level (7). RESPONSE How shall the public health movement respond to these attacks on its very existence? It could follow the submissive policy of some professional health

6 8 JOURNAL OF PUBLIC HEALTH POLICY * MARCH 1982 organizations which failed to protesthe outrageous political appointment of a totally unqualified individual as Surgeon General of the Public Health Service. Or it could take the path chosen by the American Public Health Association, which spoke out strongly againsthis nomination (8), brought the issue out into the public press, organized its membership to take action, and on this and every other issue has defended the health of the public againsthe deregulators and destroyers in the Administration and Congress and their supporters in the pro-death coalition. The public health movement has no real choice; it cannot acquiesce in its own demise. We must act immediately to organize an effective political response, both nationally and in every state of the Union, to support candidates for public office who will maintain and improve the nation's health services, and to initiate and work for more effective legislation that will bring the health of the American people to new and higher levels. REFERENCES 1. U.S. Treasury Dep't., Public Health Service. The Public Health Program under Title VI of the Social Security Act. Supplement No Washington, D.C.: U.S. Gov't. Printing Office, Gilbert, B., M.-K. Moos, and C. A. Miller. "State-Level Decision Making for Public Health: The Status of Boards of Health," J. Public Health Policy 3 (1982): Davis, K. "Reagan Administration Health Policy," J. Public Healtht Policy 2 (1981): Editorial, New York Times, November 7, 1981, p Editorial, New York Times, October 20, 1981, p. A Burros, M. "New Federal Policies Alter Food Programs," New York Times, October 21, 1981, pp. Cl, cg. 7. New York Times, October 24, 1981, pp. 1, McBeath, W. H. "The Surgeon General of the Public Health Service,"J. Public Health Policy 2 (1981):