Editor’s note: This essay deals with managed health care services in Arkansas. The firm that employs essay author John Burris represents a number of clients in the healthcare sector, including Medicaid work.
Gov. Asa Hutchinson will soon choose a new director for the Department of Human Services (DHS). With the departure of John Selig, there’s opportunity for needed change and restructuring that will finally give conservative critics what they want –whether they’re ready for it or not.
Selig announced last week his intent to retire at the end of the year. He did the job well, but not perfect. As a past chairman of the House Public Health Committee, I have observed the role is difficult, but not impossible.
In the top-job for almost 11 years, Selig oversaw the state’s largest agency and ushered through countless changes in the field of healthcare and Medicaid. He is generally regarded as honest and well-intentioned. His easy-going style made him an effective spokesman for whatever goal a governor was trying to achieve. If the responsibility ever created any stress, he never showed it.
However, criticism of Selig and his management has grown louder in recent months. Problems with eligibility systems and other programs have resulted in tens of millions of dollars wasted, and he has received the blame. Some who enjoy calling names have referred to Selig as “Beebe’s man” and have called for his firing. That’s clever, but shallow, since Gov. Mike Beebe (D) only retained him. It was Gov. Mike Huckabee (R) who originally appointed him to the job. Yet many of the most vocal Selig critics have strongly endorsed Huckabee for President. You’d think they’d blame the governor who hired him first, but that’s politics, I guess.
Hypocrisy by a few messengers aside, the criticism is fair. Selig managed the employees who wasted millions in taxpayer dollars. Long-standing software development issues were concealed mostly because of Selig’s talent of making people believe what he was saying. I don’t think he ever lied. I think he just trusted those underneath him and relayed their faulty information with his believable authenticity. I hope those employees throw him a well-deserved retirement party.
Moving forward, it’s not yet known who Selig’s replacement will be, or even what that person will be asked to do. The job could substantially change, though it’s not clear what changes the governor has in mind. He’s said recently he wanted a business-minded manager in the role. That’s a great first step.
One option would be to divide up the responsibilities. With more than 7,000 employees and divisions ranging from care of foster children to payment of Medicaid claims, it’s difficult to focus on any given area. Sure, private sector CEOs do it, but they get paid more, have directional control, and have better support staff from top to bottom.
Why not a DHS director charged with managing county operations, foster children, and other divisions, with a separate and equal Medicaid director charged with running the health benefit program? It might become more manageable and save the state money in the long run. Conservatives are usually inclined to consolidate government, but for DHS, smaller might be better. It’s better to effectively manage the spending of billions of dollars than figuring out how to save some money on a light bill.
There’s also another perspective worth considering. In some ways, the DHS director job is a lot less about setting healthcare policy and much more about managing contracts. That’s something state employees haven’t done very well. Maybe Selig’s replacement shouldn’t be the next wiz-bang healthcare genius, but simply a hard-wired audit or accountant type. Effective vendor management and enforcement of contracts could save the state significantly. The Governor’s office has increased its direct oversight of most contracts and it has improved the process substantially. A competent and aggressive DHS director could further that effort.
Selig’s departure gives a window for needed reform. The governor appears to have let him choose his own exit, which he probably deserved. But now it’s time for something different. The Stephen Group report released last week to the Healthcare Task Force made dozens of recommendations for enhanced program integrity. A new DHS director should come in ready to act on those and more.
It will be funny, though, when Selig – the Huckabee-appointed nice guy – is no longer the metaphorical whipping boy for angry legislators. It’s easy to go to a committee hearing and accuse a bureaucrat of running an incompetent agency, then leave and never run any legislation to change it. It’s always harder to do something substantive.
Now, with fresh faces coming to DHS, there’s a chance for conservatives to engage in the fight of bureaucracy management and reform, rather than leaving the field and just throwing rocks from the sidelines.
Gov. Hutchinson, not surprisingly, is setting the right tone. Others should follow. John Selig, after serving three governors, can enjoy what comes next from a distance. I think he’ll enjoy the view.