Second of three articles
The two words own a ring of urgency in a gubernatorial campaign buffeted by state budget woes, a new normal of scarce resources, the real need to streamline public services and a desire for candidates to differentiate themselves.
But waving a magic wand cannot make public service redundancies fly away, can’t force contiguous counties to gladly combine operations, or painlessly make unions negotiate contracts.
Were it that easy we might not still have or need 87 counties in Minnesota. In Greater Minnesota, 40 of the state’s 87 counties are inhabited by fewer than 20,000 people, and 23 of those counties have fewer than 11,000 residents.
Still, in-the-trenches “redesign” is under way throughout the state, with one recent example occurring here in Douglas County, home to Alexandria, a regional market center known to many Minnesotans as a vacation destination.
Last week, Sandy Tubbs, the public health director of Douglas County, with 36,333 residents, conducted initial organizational meetings with her counterparts in four surrounding sub-11,000-person counties — Pope, Grant, Stevens and Traverse –to administer and deliver public health services under the umbrella of one public health board.
For the past year, Tubbs has been smack dab in the middle of bringing the five counties together, getting approval from five county boards and seeking the ultimate redesign — someday soon — of one unified Department of Public Health.
For now, there remain three separate departments — one for Douglas, one for Pope, one Stevens-Traverse-Grant combined department — and they all receive funding through a regional board.
Still cumbersome, but it’s a start.
“If we are going to position ourselves to have a strong public health infrastructure in 10 years, we had better figure out how this [five-county setup] will work,” said Tubbs. “Anyone of us standing alone in 10 years is not going to be in a very good position to be able to assure people in our communities a good public health system.”
Public health departments do a lot. They communicate with and/or serve just about every citizen of a county, from promoting wellness issues to offering flu shots, from managing cases of low-income clients on MinnesotaCare to consulting with local schools and local businesses. Infectious diseases, environmental health hazards (such as mold), disaster responses and health issues in the region’s tourism facilities all fall under the health department’s bailiwick.
Tubbs has worked for 20 years as a nurse and administrator in a combined public health effort in Stevens, Traverse and Grant counties. She’s been Douglas County’s public health chief for nine years. After nearly three decades, Tubbs sees light at the end of the redesign tunnel.
History helps
Public health administration has been ahead of the redesign curve. It is an example of how new ideas can be activated but also how daunting a task redesign and consolidation can be.
Way back in 1976, the Legislature offered some financial incentives to county public health departments to partner and work together. Community health boards — umbrella funding vehicles — were established to allow for multi-county partnerships.
Incentives for some cost-cutting for groupings of 30,000 clients in three or more contiguous counties were put in place. It was voluntary for counties to combine. Some did. In many cases, there was limited working together on public health delivery but simply a combination formed to receive funding and grants together.
But times and demographics have changed dramatically, as has health care costs and delivery. As various state and federal grants grew, as the populations in Greater Minnesota aged and diversified, it became clear that combining these five counties into a unified entity made sense: A recent State Community Health Services Advisory Committee report, citing respected academic literature, noted that communities with 50,000 people or more can deliver public health services better than groupings of fewer than 25,000 and more than 500,000.
In the case of these five combined counties, not only do they reach more than 65,000 residents combined, but each county has its own characteristics: Douglas is “incredibly white,” said Tubbs, with Traverse having a sizable American Indian population and Stevens a growing Hispanic community. When health care companies, such as Blue Cross, or the federal government fund public health initiatives, this five-county partnership will be in better position to win grants because of its collective size and combined diversity. For the near term, the new partnership won’t drive much cost savings for the counties, Tubbs said. It will reduce duplication of tasks for employees, however. Over time, she envisions cost savings.
County tensions
But the political act of combining services among counties isn’t a slam-dunk. Tubbs, who works for “large” Douglas County, was asked by elected members of her county board, “Why do we need them?” meaning the smaller surrounding counties. “We’re 36,000 people.”
Meanwhile, the less populous counties worry about being swallowed up by Douglas County.
“When we have been in this government pattern, operating in these arbitrary lines that are called ‘counties’ for so many years, it’s not natural to then try to imagine those lines don’t exist,” Tubbs said. “It isn’t easy.”
Gubernatorial candidates Tom Horner of the Independence Party and Tom Emmer of the Republican Party have each talked about the need for “redesign,” although they seem to mean different kinds of redesign. But there is a trend across the state already for county and city administrators to seek cost-cutting and better delivery of services.
Janet Raguse, coordinator of Traverse County, the least populous county in the state with 3,581 people, lists about 20 different multi-county initiatives that Traverse County is part of it, from an 11-county public transit program to a nine-county emergency preparedness arrangement to a probation consortium with five counties.
But, in an email to MinnPost, Raguse said she opposes the notion of reducing the number of counties: “Rather than combine or eliminate counties, the collaborative model for services should continue to be explored in all counties. It is vitally important that Traverse County continue to meet the needs of and provide services to its citizens, and the county has been able to do so through creative, resourceful ways. If counties are combined or eliminated, rural citizens would lose their voice.”
As for real savings at the city and county level, they are likely limited. After all, most small cities have been affected by severe cuts in Local Government Aid and counties have been whacked, too, by the reduction in state funding because of the state’s $6 billion deficit. They are operating at bare-bones already.
All houses and business real estate still need to be assessed for tax purposes. But does every small county need its own assessor? Does every city need a police department? Does every town need its own administrator?
It all depends. Take a city administrator like Jamie Beyer in Wheaton, the largest city in Traverse County, but with a population of 1,449.
She handles all city business and public works, plus serves as staff to the city council, handles election matters and is webmaster of the city’s website and city liaison with the county, among other things.
The idea that, maybe, she could administer the business of a handful of other Traverse County cities doesn’t appeal to Beyer, who is paid about $55,000 a year.
“I don’t quite understand how that would work,” she said. “We have to plow the streets here, we have to patch the streets here, we have to mow the parks here. What would you do? Have another shop in a central location and more equipment? For as busy as I am working on all this stuff, there isn’t always an overlap, and especially when you’re working with elected officials.”
And Minnesotans like access to local elected officials.
Tubbs warns that, from the outside looking in, no two program or agency consolidations can be the same, no cookie-cutter approach imposed from on high by a new governor or overactive Legislature will work.
If “redesign” can be done — from public safety to public health, from human services to street paving — it must come, Tubbs said, with a vision from the top — the governor’s office — but via the hard work of hundreds of local government employees and elected officials, all willing to navigate the sensitivities of county boards, state agencies and community identity.
“What I would not recommend is a top-down redesign,” she said. “If it’s really going to work and function, it has to come from the locals.”
As for why there hasn’t been more consolidation of service delivery among city and county officials — from county assessors to police departments to public works to public health — Tubbs replied bluntly, “Because they don’t have to.”
Somehow, without dictating terms, a new governor and Legislature must establish incentives for counties and cities to work together, she said.
In her role as Douglas County public health director, Tubbs last week was put in charge of quality improvement and planning for all five counties in the new consortium, called the Horizon Community Health Board. Other region-wide responsibilities were parceled out to her colleagues from the other counties.
Tubbs’s goal has long been to see one public health department for Douglas, Grant, Stevens, Traverse and Pope counties by the time she retires. She soon turns 57, working and hoping for one little victory in the tough battle for the redesign of government.
Friday: The gubernatorial candidates on LGA and redesign
Another fine piece, Jay. I had no idea my comments on the first piece would be prescient to this degree. Too bad that prescience doesn’t carry over into other areas.
It’s a complicated issue, in line with my experience in Colorado on several levels.
As you’ve written, everyone likes to feel like they have access to people in government who will listen to them, and even better if they know those people personally. That this might lend itself to inefficiency, through duplication of services and unnecessary cost, either doesn’t occur to a lot of people, or if it does, their conclusion is that the extra cost is worth it for “personalized” service. “Local” and “local control” get to be mantras that are often repeated. Not always, but often, it’s the right idea, and I’m in agreement with Sandy Tubbs that “top-down” reorganization and redesign will likely have a much harder time being effective and efficient than letting the locals work it out among themselves, with some very broad guidance from St. Paul.
That said, however, almost anyone who’s worked in local government is familiar with the attitude, if not the exact words, of Sandy’s comment regarding the question of why there hasn’t been more consolidation of services and delivery between and among cities and counties in rural areas – “Because they don’t have to.” It’s a tough mind set to overcome, and regional thinking is difficult to put in place when County Board members or commissioners basically reply as their unnamed Douglas County counterparts did – “Why do we need them?”
Often, the answer, at least in literal terms, is “We don’t,” at least in the short term, but a generation down the road, one of the few things we can count on is that whatever rural Minnesota (or urban Minnesota, for that matter) is like right now, it won’t be quite that way in 2035. Technology will change, government will change, the economy will change, and individuals and governmental entities will both have to adapt to those changes, whatever they happen to be.
I don’t know enough about rural government to be able to disagree with Janet Raguse very forcefully, and she may have a very good case, but I’m not yet convinced that consolidation would necessarily mean that rural citizens would “lose their voice.” It seems possible to me that consolidation might, in fact, make the voices of rural Minnesotans heard more effectively – at least under the Capitol dome – and off the top of my head, it would seem that the conclusion of the State Community Health Services report – that communities of 50,000 or more can deliver services better than communities of less than 25,000 or more than 500,000 – might well apply to several areas of public agency service that are well outside the bounds of public health.
I look forward to the next piece in the series, as well as other commentary, to fill in at least a few of the many gaps in my knowledge.