The Governor's New Proposal

Well, that was fast. The three-month late annual budget lasted six troubled weeks and now the legislature is back in session, ordered by the Governor to redo the math. In the governor's proposal is a 3% payment reduction to regional center vendors and a 3% cut to regional center operations. Vendors and regional centers would be hurt a little. Also on the table are cuts to SSI/SSP, IHSS and MediCal. People with disabilities could be hurt a lot.

What ought to also be considered is how to make some of the cuts less damaging. For vendors and regional centers, that means relaxing some compliance costs. While the transition to genuine and efficient outcomes-based accountability will remain beyond the scope of the special session (and the grasp of the legislators,) authority could be given to DDS to reconsider some of its regulations on a cost-benefit basis. As of right now, regional centers and vendors have the power to reduce some of our more paper-centered activities. While accountability of some form is absolutely critical, there is a conflict between cost and agility on the one hand and compliance on the other. I suspect if we looked more analytically and honestly, we'd find we err far on the latter side. Of course, if we were more analytical and honest, we'd all be bankers.

The Obama rate increase

Apologies for my absence, it's likely to continue, but I wanted to point up that the Obama economic recovery plan which will not occur regardless of who wins in the election includes a $3000 tax credit for small businesses who take on a new employee.  For my colleagues in the executive directing business with high turnover, this plan could really add up.  Be careful, though, spend it on wage increases and you risk killing the goose that laid the golden egg.

Channeling Paul

In the comments to the post below, Paul wrote: 

Doug,

Have you noticed that over the last several years we have “hammered out..” a budget that actually shrinks our opportunitu to hammer out one in the future? What I mean is this…

As we shift more and more to federal funding as an answer to our budget we become more and more enslaved to the whims of federal budget makers. Is this the Sacramento’s fault? Ultimately I would say yes, after all they are the ones that say yeah or nay.

But lets be fair – we do not need to search far to find fantasies and fallacies about unmatched state dollars, waiver, backfill, and outrageous numbers like 1.4 Billion in untapped federal monies. In fact, we do not need to search at all. The advodivas, the advocrates – the politicians are within our own ranks.

How can we not love a person that implies through poignant protestation that we are being short changed 1.4 Billion dollars? We love him or her just as we love the politician that tells us that he or she will cut our taxes and double our entitlements at the same time.

Until we can address our realities Andy words are axiomatic, “It does not, will not, cannot exist in our government.” Until we acknowledge that some of our efforts at home are, “little more than the brightly-colored bunting and balloons of a democracy”

I have noticed, just as I noticed that you said articulately something I've been trying to squawk out for the lifetime of this blog. Missing from his list is the amount of time, energy and audience we waste debating the prevalence of "classic" autism.  There are a few problems that I would identify in our approach:

1.  We argue with the idea of waste in the system before looking for it.  If there is waste in the system, and we all know there is, it is interfering with effective support for people with disabilities and counteracting the well-spent funds.  If there is waste in the system, identifying and eliminating it would be that much funding we would not have to defend.  That we find so many ways to fight against the unexamined implication also allows those who would cut our finding to decry wasteful spending without expectation of quantifying it.

2.  That we even care what resources might be available takes the conversation away from the mission and into the money.  We will never win an argument about money.  We have people who need and deserve our support.  They are compelling people, sympathetic people and above all, people.  It is easy to not care about acronymmed arcana like FFP.  It is hard to dismiss a human striving to overcome a profound challenge.

3.  Nothing depresses me more than the number of my dear friends in the DDS advocacy community who have been saying for 8 years that we can't start the important fight until funding is secure.  Funding will never be secure.  As long as you think funding comes first, you have surrendered the battle for everything you say matters.

How to have self esteem when you're a DD service provider

I may be, as a social services chief executive, a member of a despised class rightly suspected of promoting unaccountable, dishonorable and inefficient expenditures.

I may be, as an advocate, a typical charlatan using blubbery words to ask my neighbors to place my interests above their own.

I may be, as a blogger, the tea-totaling equivalent of that obnoxious souse at the bar holding forth on matters beyond his ken as if an alcoholic haze were a worthy substitute for any actual knowledge.

I may be scandalous, stupid and self-important, lazy, long-winded and loveless but I am not a California legislator, Alhamdulillah!

The opportunity for Democrats and Republicans to demonstrate their commitment to principles has passed and it passed with no creditable gestures toward principle.

The opportunity to hammer out a smarter, leaner or more compassionate and just budget passed with no apparent fervor for smartness, leanness, compassion or social justice.  

It is time for the legislators to stop pointing at one another. It is time to vote for a flawed, inefficient, stupid budget because this year's budget has gestated too long not to resemble its parents.

Selah

P.S.  The above was provoked by an email sent by State Senator Dutton to supporters sharing Pete Wilson's criticism of Schwarzenegger's budget plan.  In all likelihood, all of his colleagues in both houses are sending similarly sanctimonious and second-hand commentary to supporters (more and more loosely defined.)  As a supporter, I wanted to explain the following:

Drug dealers may be predators, but they perform.

Government contractors may be parasites, but they are humble.

Undocumented workers may be illegal, but they do what they are paid to do.

People with severe enough disabilities may not be as economically productive as their non-disabled peers, but many accept wages in consideration of output.

In short, there is nobody in this state that any member of our legislature might wish to punish, prosecute or patronize who is not a better public servant until a budget is presented the governor.  Until then, criticize no one.  

Capitalism, Freedom and Inclusion

I have been re-reading Milton Friedman's Capitalism And Freedom, may God have mercy on my wretched soul.  Here is a passage I find relevant to the discussions here:  

"The characteristic feature of action through political channels is that it tends to require or enforce substantial conformity.  The great advantage of the market, on the other hand, is that it permits wide diversity."

 Far more elegantly (and probably more glibly) than I have done, Friedman makes the case that I have tried to make (e.g. here and here,) that in asking DDS to provide too many assurances we not only create inefficiencies in the system by encouraging more central planning of the lives of the individuals served, we also undermine the inclusiveness the society we claim the intention to open.  Following Friedman's argument, the more activist we ask DDS to be, the less able our system will become to model the inclusiveness we promote. 

"...a major source of objection to a free economy is precisely that...it gives people what they want instead of what a particular group thinks they ought to want.  Underlying most arguments against the free market is a lack of belief in freedom itself."

Incidentally, openness to diversity includes patience with extreme nerds,  For those interested, the reason I am rereading this book which was written the way Alan Greenspan speaks is an online book club being hosted by Free Exchange, the economics blog sponsored by The Economist newspaper's online entity.  Anyone unlovable and fascinated may wish to participate but please behave and don't tell them I sent you.  My subscription is my only friend besides my dogs, and they're Keynesians.

Entitled to what?

Paul, maskless, brings up a very good point in the comments for the aging post below.  He states "Since I have found wide and interesting interpretations of the Lanterman Act I want to start where I hope we can agree. Client or families [SIC] goals are not implicit entitlements under the Lanterman Act."

I'm inclined to agree.  One of the challenges to the present system and any future better one is distinguishing between the outcomes of support and the results that are in the control of the end user.  It is fairly clear and I suspect uncontroversial that the entitlement is to service and support for the purpose of moderating the affects of developmental disabilities on the lives (goals) of the individuals served.  I might argue the proper outcome measurement for a service provider or regional center is a process measurement for the end user.  The quality support may not have to result in a person with disabilities experiencing success, but in their succeeding or failing the same way a person without disabilities would.

And yet, much disenchantment is with the event that people with disabilities are still unhappy and/or unfulfilled after receiving services.  Here lies one of the problems with using client satisfaction as an outcome.  Another lies in the fact that achievers are rarely satisfied.

I'd be interested to hear your thoughts.  Especially yours, Stanley, you old crank.

Incidentally, Monday marked the fourth anniversary of this blog even if I didn't.  Thanks to all of you have joined the conversation over that time.

Families and Reform

The Apostle Stanley is stirring it up in the comments in the post below this one, comforting the afflicted and afflicting the rational.  His comments have inspired some thought on my part, no mean accomplishment.  

If you look through this blog over the years, those reforms I argue for most consistently: transparent and public outcome evaluations of programs and policies, self-determination and its pale cousin self-directed services and value-stream management share a common assumption: That end users of the system, given the means and opportunity to do so, will choose quality supports providing the maximum likelihood of achieving the client or families goals.  It is on this basis as well, that I tend to kick against top-down, regimentary solutions such as those Stanley suggests.

I make this assumption in direct contradiction to some experiences I've had.  I am often at meetings with groups of clients and/or family-members gathered for the purpose of advocacy.  Often at those meetings, complaints are rife towards service providers and regional centers.  The commonest answer to "have you discussed this with your agency/regional center?" seems to be "I am afraid they will retaliate."  The commonest response to "Have you considered changing agencies/service coordinators?" seems to be "It's a lot of work and, anyway, the next one might be worse than the last." 

I recently told a good friend after one such meeting of my suspicion that if mediocrity in a service provider cost money, excellence would abound.  Likewise, I suspect that if listless service coordination made extra work, service coordinators would struggle to be responsive.  

I am sure fears of retaliation aren't entirely unjustified and I certainly grant (and assert) that discovering quality supports is impractically hard.  But, if end users won't seek alternatives to poor service, then Stanley is probably right, the only way this system will get any better is a top-down process that will also make it less creative, innovative and diverse.