Do we truly know what programs deserve to be on the chopping block?

It is interesting that so much money is spent annually on the provision of health and human services in Hawaii, yet serious discussions about if this money is being spent efficiently and effectively are not taking place. Sixty percent of the total State budget is spent in these areas: 25 percent on education, 16 percent on health services; 10 percent on welfare, and 9 percent on public safety. And while legislators hear about the litany of social problems besetting our communities, (for example the rise in homelessness; increases in family violence; increases in Medicaid and food stamp applications), it is often not clear why money is being appropriated to certain programs and not others.

For example,  the previous administration took a heavy axe to Hawaii’s home-grown Healthy Start Program, which had been studied for years by independent evaluators and found to be extremely effective (and efficient) in supporting families and preventing child abuse and neglect. It actually has become a national model and implemented in many other states, but it was slashed to pieces in Hawaii. Why are there not serious conversations about the efficiency and effectiveness of the hundreds of millions of public dollars going out to for-profit companies as well as private non-profit agencies that are now doing a large percentage of the public’s work?  I believe that most do excellent work, but who really knows?

Over the last several years, as long as the federal government was paying our bills, there wasn’t much attention to cost effectiveness. Hawaii (along with most of the other states) happily spent billions of federal dollars and blew up the national deficit to its now, unsustainable level. Many essential State services and obligations were shifted from State funds to federal funds. This seemed like a fine idea, except that those federal funds have dried up and the State is left holding the bag. The Abercrombie administration is currently saddled with a huge fiscal crisis.

I recently heard on NPR that Rep. Doug Lamborn (R), a Congressman from New York, wants to cut all governmental subsidies to public radio. He contends that “if the private sector doesn’t want to invest in something [like public radio or public TV], then neither should the government.” This is quite a novel and quite frightening idea. Does he mean that if the private sector doesn’t see a way to make a profit, then the government shouldn’t invest in those areas either? Programs that support persons with mental illnesses or help for those with substance abuse addictions rarely get into anyone’s private investment portfolio! 

An interesting example of how federal money can be used to force states into performance-based activities are the “Race to the Top” grants for public educational reform. All 50 states applied for this $4.35 billion fund, but only 10 states received funds (Hawaii was a winner). The focus is on accountability. The money must be spent on “improving teacher and principal effectiveness, based on performance.” It would be good if performance were the primary goal for the rest of our health and human services programs ... and funding followed.