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June 3, 2013

Paying the Price or Not

Richard B. Weldon Jr.

The public's reaction to the Frederick Board of County Commissioners on a number of controversial decisions lays the groundwork for the 2014 campaign.


Like most political decisions, there are two sides to every argument, but some clear trends are emerging. The question will come down to which side is more compelling with the electorate.


These arguments also bring into sharper focus the whole issue of changing our form of government, too. We see what happens when a clear voting majority emerges on controversial issues, but it begs the question about what happens when one person has executive control over the operation of the government and can move big issues without the "inconvenience" of a multi-member consensus process.


Sure, we'll also have a county council, but if you carefully study other counties in Maryland, the county executive under a charter is the thought leader and decision-maker, while the council is often relegated to the role of complainer-in-chief.


We can examine a number of specific issues, but one best frames them.


Citizens and Montevue – This issue has plagued the county for decades. Nursing homes are difficult management problems, merging federal financial issues (Medicare), health care quality, extended life for an aging population, baby boomers and cost containment.


Frederick County is one of a few Maryland counties that continues to operate a publicly-backed nursing home. Other counties have backed out, bringing in private companies to either run the business under contract or to completely take over the facilities completely.


While the cost to county taxpayers is an issue, many perceive the obligation to poor seniors to be an absolute commitment on the part of the government. Fears that the elderly, unable to provide for their own care, will be put out on the street causes many to argue for continuing the relationship.


A majority of the current commissioners argue that the private sector can run a nursing home better than the public sector. History is clearly on their side. Even in Frederick County, we know that to be true.


Over a decade ago, a past group of commissioners decided to end the practice of having a nursing home director as a direct county employee. A management contractor was brought in, reporting to a commissioner-appointed board of directors. That decision followed a very bad inspection by the state Office of Health Care Quality. I know this because I was on that Board of County Commissioners.


The intervening years have borne out that logic. The problems noted in that past inspection were eliminated, overall care quality improved and new facilities were designed and built to address the more complex brick and mortar issues.


The issues that even an excellent manager couldn't impact were the growth in healthcare costs and an increase in the number of senior citizens unable to provide for their own long-term care. County residents continue to subsidize these facilities at a fairly substantial cost, and that appears to be a likely scenario for a number of years to come.


The current Board of County Commissioners is moving forward a plan to privatize the nursing home and long-term care centers. Ignoring their own appointed board of directors, a majority of the commissioners seems convinced that the private sector is better equipped to operate these facilities.


On the other side, the aforementioned board of directors led the argument that they've never really been given the free hand to run the facilities. They argue that if they had the tools to actually do the job, they could make it work. There appears to be some legitimacy to their point, in that they may not have been provided with long-requested direct control over some aspects of staffing and decision-making.


A darker and more ominous argument is the fear that – without a county-backed subsidy – the number of beds reserved for private pay patients will rise significantly, eliminating the chance for future indigent Frederick County seniors to find a bed. Private sector nursing homes are driven by the need to provide a return for shareholders that could ultimately offset patient needs.


Commissioner President Blaine Young has been the most visible backer of the privatization charge, but he has three solid supporters in Billy Shreve, Paul Smith and Kirby Delauter. All four county leaders agree with the general idea that if the private sector can do something, then government should not.


Commissioner David Gray serves as the loyal opposition, as he has on most issues since this board was elected. It often seems as though he's trying to be obstinate, but the truth is that he was never really aligned with majority, going back to the campaign.


Under a charter, the council would have to vote to sell the facilities to a private entity. The county executive would have the obligation to set up that sale, to run the proposal process and evaluate the bidders. The executive would also have the bully pulpit and the obligation to educate the electorate as to the rationale for the sale.


My point in offering this lengthy example is to make a recurring point about charter government. I've argued for years that this form makes more sense than the current form for operational purposes. From a political standpoint, I've also argued that the form of government is less important. The nursing home debate conclusively proves my argument.


Blaine Young has at least two, more likely three, solid votes to award the sale of these facilities to the best-qualified bid. Had Mr. Young been the county executive, he would have done all of this the same way, and would be presenting the sales contract to the county council. Instead of taking several public meetings to get to this point, much of this groundwork would have been laid in private.


You see, the form of government is not as significant a factor as is the person elected to serve.


Regardless of whether we're talking zoning, budget, the environment or elder care, if we elect a traditional conservative executive, we can expect a traditional, small government, conservative approach to governance. Likewise, if we elect a progressive, we'll see a heavier reliance on traditional bigger government.


Like the current struggles with divided government in Washington, a political divide between the county executive and the county council could either serve as a check and balance or an advanced form of policy-making gridlock. A sense of political unanimity between the executive and legislative branches could either result in an efficient government process or a dangerous group-think love fest, bereft of the minority viewpoint.


It will all depend on who we elect.


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