By MICHAEL D. KLEMENS
Edgar v Hartigan on welfare, health care, mental health
This is the second in a series of four interviews with gubernatorial candidates Jim Edgar and Neil F. Hartigan. The first interview, on taxes and state finances, appeared in our July magazine. Interviews on economic development and education will appear in October. For this session on human services Edgar and Hartigan were asked to be prepared to offer specific proposals in welfare, health care and mental health. The interviews took place July 31.
Government provides for those who cannot take care of themselves. Approximately 45 percent of Illinois state government's $13 billion general funds budget is spent on human services. Human service spending pressure is unlikely to abate soon because the federal budget deficit has choked the flow of federal dollars and increased the pressure on states like Illinois to provide human service money.
The needs in human services are heartbreaking from a single mother trying to raise two children on a welfare check to babies born with cocaine addictions. Indisputably the needs outstrip the resources. The question of human services is ever on the mind of governors, and answers will be especially tough for the next Illinois governor, who will face both human service spending demands and limited resources.
Sharp differences emerge between the two gubernatorial candidates on human services. Secy. of State Jim Edgar, the Republican standard-bearer, promises incremental changes in the way the state delivers its human services, given the limited resources. Atty. Gen. Neil F. Hartigan, the Democratic nominee, assails Illinois' current efforts and promotes a wholesale overhaul of human services delivery.
Hartigan maintains that Illinois does a poor job providing human services and that all human services have deteriorated under Gov. James R. Thompson. Hartigan cites statewide infant mortality rates that are the sixth worst in the country, lack of programs to deal with homelessness and 1.5 million Illinoisans who have no health insurance.
In contrast Edgar says that he has seen improvement in state human service efforts during his 22 years in Springfield. State government spent little on senior citizens when he first came to Springfield, he says, but today spends more than $1 billion per year. "Children and Family Services 22 years ago was considered the model department in state government, but it hadn't yet taken over from Cook County the responsibility for children." The GOP candidate says the state could do better, but he would not say Illinois does poorly.
The top human service priority of a Hartigan administration would be health care. He sees evidence of crisis in infant mortality rates, closed hospitals and hospitals that have withdrawn from the trauma network that provides highly skilled emergency services. Hartigan says that Illinois has contributed to the problems by setting rates low for the care that hospitals and doctors provide to the poor under the state's welfare programs, and then paying the bills slowly: "By being the worst entity in the state to do business with, the state further exacerbated the problem." Edgar's top human service priority would be prevention of child abuse. He says that caseworkers in the Department of Children and Family Services carry workloads that are too heavy. Edgar suggests that coordination of social services through schools could be efficient. "When you talk about a child at risk, you've probably got a family at risk," Edgar says, suggesting that some pilot programs are in order. Edgar also says that outside forces will dictate some priorities, citing the federal requirement to move mentally ill and retarded out of nursing homes. Both candidates see need for improvement in the way that
Secy. of State Jim Edgar. . . promises incremental changes in the way the state delivers its human services, given the limited resources
20/August & September 1990/Illinois issues
Illinois approaches human services, although Hartigan claims that his changes would be an outright overhaul of service delivery. Missing in Illinois, he says, is a planning process to determine needs. "Bringing order out of the chaos is the first thing you do." Hartigan says that he would get the best and the brightest from the public and private sectors to design the human services agenda with him.
After he decides where Illinois ought to be headed, Hartigan would take a more individualistic approach to the delivery of services: "What I've tried to do in everything I've ever done is to measure the service by the effect that it has on the human being."
Toward that end Hartigan proposes use of case managers, trained in more than one service area so they are able to refer clients to the appropriate services. He argues that those needing help are unable to find their way through the red tape to available programs: "Instead of having 15 different sets of case managers [for each state service] that the consumer, who hasn't been given any sort of real information, has to fight his or her way through . . ., I'd start by getting rid of that kind of overlapping bureaucratic mess and cross train the people [in human services agencies] to be case managers in a real sense, almost on an ombudsman basis," Hartigan says. But Hartigan says it is too early for specifics, lest he tip his hand to his opponent.
Besides the increased use of case managers trained to handle individual "consumers" for all state human service programs, Hartigan would also deliver as many services as possible at the local level, including some of that case management. The principle is that the best service is the most accessible, and a locally based case management service would be ideal, Hartigan suggests, with the case managers trained to know state, local and federal resources that are available to citizens depending on their needs.
Edgar's changes would be much more modest. He believes that to make best use of scarce resources state government must be certain that agencies are working together, not fighting turf wars. He says that his office saw the need for more cooperation when the secretary of state got into the literacy field: "It just seemed to us as the outsider coming into this that there was aneed for more coordination." He likewise believes that state government must be careful not to overwhelm local service providers, public or private, with red tape or other requirements that get in the way of providing services.
Given scarce resources, Edgar says that he would emphasize prevention programs, where a small investment can prevent larger expenses later. Specifically, he believes that money spent on prenatal care and for young children's health care or nutrition can make it possible later for children to succeed in school. Providing health clinics to treat colds before they become pneumonia, says Edgar, can take the pressure off hospital emergency rooms and save money.
Edgar's top priority is education. He points out that there is an inevitable tie between education and human services. "An awful lot of the need, I think, to improve the schools is going to be tied to social services."
Spending on the Department of Public Aid accounts for more than 30 percent of all state general funds spending. It is the largest single chunk of state spending, exceeded as a category by education when lower and higher education are combined. And it is spending that the poor claim is too low and that other citizens criticize as extravagant.
Generally, Hartigan argues that income support and other welfare programs do not work in Illinois. He says the state needs to support those for whom alternative job training programs aren't feasible, but he cannot yet say whether that current support level is adequate.
For those who are able to work Hartigan sees the need for a range of services to assure them a real opportunity for a job in the future labor force. Affordable housing is one need. Day care is another. Health care is a third. The quality of the job for which training is provided is yet a fourth. He lambasts the current state job training. "Project Chance is called Project Fat Chance out on the street," says Hartigan of the job training program for welfare recipients. He criticizes the proliferation of 15 job training programs in Illinois that he says "fall all over themselves." He says that government must work with business to decide what jobs will be created and to target Project Chance-type training for those jobs.
Here Hartigan again invokes his "run government like a business" theme. He points out that there will be new jobs and new fields that people must be trained for. He cites as example the environmental area, saying there will be jobs cleaning toxic waste, dealing with asbestos in buildings and recycling materials. "I see these human beings [those on welfare] as elements in economic development. We've looked at them as though they are the drags on society."
In Edgar's view, government needs welfare programs to take care of those who can't help themselves, but that those able to work should with an exception for mothers of very young children. For those who should work, Edgar says, "If they don't have the proper training, then they ought to be required to be in some type of vocational training, even though it might be very low level, like a literacy course."
Atty. Gen. Neil F. Hartigan. . . assails Illinois' current efforts and promotes a wholesale overhaul of human services delivery
Edgar says that Project Chance is working but is probably due for a reevaluation. The program has produced both horror stories and successes, he says. Edgar says that philosophically he favors help for the working poor, those who hold jobs but are having trouble making ends meet, but he will not commit to new high cost programs. Edgar's vision for welfare programs is to stress putting people to work: "If you can demonstrate to the public that we are encouraging or requiring people to improve their skills to find a job, then they're not opposed to helping
August & September 1990/Illinois Issues/21
them in the meantime or supplementing their income." Health care is a growing concern, nationally and in Illinois. Costs are soaring, causing problems for citizens and raising state costs to care for the poor. And in rural and inner city areas medical service is simply not available.
Hartigan would call together all interested parties doctors, nurses, hospitals, nursing homes, consumer groups and insurance companies to find a solution to high costs. He would also bring business, which provides health insurance for its workers, to the table. Hartigan argues that with all that Illinois spends on health care, it can set quality standards and control some costs.
In terms of where the state puts its health care money, Hartigan believes that emphasizing primary care and prevention would be most logical: "If we go with prenatal care and postnatal care, then for every dollar you spend there I think the estimate is that you save three dollars in terms of the health care costs of the child once it is delivered." To Edgar, resolving the health care crisis in Illinois first requires the decision nationally of where responsibilities lie among the federal, state and local governments. Edgar also says that business will play a key role in deciding how health costs can be contained. The business community push for limits on medical malpractice costs is one example of their efforts, says Edgar. And with their large investment in employee health care, Edgar thinks that business may have even more leverage than state government in restraining costs.
Edgar sees a state role in trying to assure accessiblity to doctors and health care where it is hard to find them now the inner city and the most rural parts of Illinois. One solution he suggests could work is expansion of scholarships for medical students, who would then be required to spend time in the under-served areas. Edgar also believes that clinics providing primary care might be suitable replacements for small rural hospitals that have closed.
Edgar believes that the new governor will have a role in the new Cook County Hospital: "I think it'd be crazy to just create another Cook County Hospital with the same bureaucratic problems and headaches." Edgar said that he would not commit state money unless Cook County Hospital were made more efficient.
Edgar: 'I think it would be crazy to just create another Cook County Hospital with the same bureaucratic problems and headaches'
Mental health, which Ann Kiley, former mental health director, described as "shreds of a system, is a continuing human service problem. With more than 13,000 employees, the Department of Mental Health and Developmental Disabilities is the largest agency in state government. In general funds' human service spending, it trails only public aid.
Hartigan says the first responsibility of state government is to comply with the federal requirement to move mentally ill out of nursing homes where they are warehoused. In the field of mental health, Hartigan would like to see more preventive efforts, and he advocates properly funded community-based services. He would restore state mental health professionals to positions of authority: "It has been very difficult for the professionals in the department to stay there."
All that would take a lot of money. The Governor's Commission to Revise the Mental Health Code constructed a model for services in its 1989 report that would have set state spending at twice current levels. Hartigan said that he is unfazed by the cost because he believes there are huge amounts of money being spent unwisely. ' 'If I accept the idea that I can't do anything with $26 billion and $400 to $500 million in new revenue
Jim Edgar on human services
"Some have argued that the need is a lot greater, but whether you're dealing with senior citizens or dealing with children, there is a lot more state activity, a lot more state support, than when I first came to Springfield 22 years ago."
"We're going to have to figure out how we can get the most for the limited resources that we have available."
"If I have a limited amount of dollars and all these worthwhile projects, if both things are equal, I would probably go with the measure that's going to be in the area of prevention because I think that we'll have more results from the use of that resource."
"If we can do it early and try to head off the problem, it's going to save misery, and it's going to save dollars."
"I'm not of the mind that we necessarily pass laws and say, 'Business, you have to provide these 14 services to your employees," because I think we'll ran into problems."
"I'm not in favor of expanding centralized state services or state facilities."
"I think it's difficult to really separate . . . human services and education because an awful lot of the need to improve the schools is going to be tied to social services."
"I think most people, regardless of their political philosophy, think we should help people who can't help themselves."
"I think a clinic in a small town might suffice versus every community having a hospital."
22/August & September 1990/Illinois Issues
Jim Edgar, Republican for governor
Secy, of State Jim Edgar at age 44 is getting his long awaited chance to run for governor. Talk of Edgar as governor has been around for 10 years, since Edgar was appointed to his present position in 1980. In May of 1986 U.S. News and World Report named Edgar as one of 30 rising stars in American politics.
A native of Charleston, Edgar was graduated from Eastern Illinois University in 1968 with a bachelor's degree in history. He served as student body president at the university. Edgar is married to the former Brenda Smith of Anna. The couple lives in Springfield. They have two children, Elizabeth, 16, and Brad, 22.
On their 1989 income tax return the Edgars reported adjusted gross income of $68,212. nearly all of it from his state salary as secretary of state. The Edgars paid $9,363 in taxes on their income. Their largest itemized deductions were $7,069 in mortgage interest on their house and $3,920 in contributions to the Central Baptist Church in Springfield.
Edgar began his career in state government in 1968 as a legislative intern and later as staffer to Senate President W. Russell Arrington. Over the next six years he worked on the staffs of Republican leaders including House Speaker W. Robert Blair, Senate President William Harris and House Minority Leader Bud Washburn.
In 1974 he left the staff to run for the Illinois House of Representatives from the 53rd District. Edgar finished third in a three-way Republican primary. In 1975 and 1976 he worked as director of state services for the National Conference of State Legislatures in Denver, Colo.
In 1976 the 53rd District House seat became open again. Edgar returned to Illinois, marshalled support and won election to the seat. He was reelected in 1978. In 1979 Gov. James R. Thompson convinced Edgar to leave his legislative seat to become director of legislative relations for Thompson.
In 1980 the resignation of Adlai E. Stevenson III from the U.S. Senate opened another opportunity for Edgar. Secy. of State Alan J. Dixon was named to Stevenson's seat and Thompson appointed Edgar as secretary of state, bypassing George H. Ryan whom he would later tap as his lieutenant governor.
Edgar won reelection in 1982, making him the youngest secretary of state elected in this century. He won again in 1986 amassing the largest statewide plurality in history against the LaRouche-weakened Democrats.
Edgar has been an activist secretary of state. He is best known for his crusade against drunk driving. Upon assuming office Edgar said he looked for areas in which the office could have an impact and decided that drunken driving was one area that needed stronger legislation. Edgar said that having viewed some of the compromises involved in passing the original legislation he knew where the weak points were.
As secretary of state he pushed for new laws that now allow police to immediately administer sobriety tests to suspected drunken drivers, require courts to notify his office of cases where a driver was given court supervision in lieu of conviction so that convictions can be monitored, and make suspension of driver's license automatic for those who refuse a sobriety test.
In another driving related matter, Edgar pushed and finally passed a law requiring all Illinois vehicle owners to carry insurance. The 17-year campaign ended in fruition in 1990 with the requirment that all vehicles carry liability insurance. The law is administered by Edgar's office.
Edgar has also increased the profile of the state librarian, a duty of his office. As state librarian Edgar has championed literacy programs. He has worked with community volunteers, educators, business and labor to establish tutoring programs for the estimated two million adult Illinoisans who cannot read. Edgar has also worked as state librarian to increase state funding for construction of public libraries.
Finally, Edgar has advocated for the disabled. As secretary of state he returned the manufacture of license plates from out-of-state to a sheltered workshop in Decatur, a move that provided work for the handicapped and saved taxpayers' money. Secy. of State Edgar claims state government's best record for hiring the handicapped outside of the Department of Rehabilitation Services.
Edgar also cites:
Issuance of driver's licenses for four instead of three year periods.
Creation of the "Read Illinois" program to promote Illinois' literary heritage.
Formation of the Department of Senior Citizens and Human Resources within his office.
Efforts to expand availability of handicapped license plates.
Rewriting of the Business Corporation Act and the Illinois Security Law.
Professionalization of the secretary of state's police and directing their efforts toward auto theft prevention and combating of odometer rollbacks.
Color coding minor's driver's licenses to make it harder for underage persons to buy alcoholic beverages.
Michael D. Klemens
August & September 1990/Illinois Issues/23
every year and that absurd job that's been done in terms of recapturing federal resources, then I shouldn't be running for this office."
Then Hartigan came very close to using the T-word: "If I got to the point where I honestly believed that I couldn't accomplish what really needed to be done, I'd have the credibility because people would have seen me do everything that was humanly possible to get the job done with what's there. Then you've got a basis to go to the people and explain the problem to them. I'd be willing to do that. I've done that before."
Edgar said that steps must be taken to improve mental health services, but he predicted that progress would be slow: "I think in the past maybe there has been a tendency just to ignore it or to have another study. It's also something we're not going to solve overnight." Edgar said the state could not spend an extra $300 million or $500 million on mental health services.
Like Hartigan, Edgar would like to see more preventive measures taken in mental health. He thinks the state must insure that housing and jobs are available to the mentally ill released from institutions.
In mental health and in other services both candidates would emphasize community-based services. "The service closer to the community more community-based frankly is far more effective traditionally," Hartigan says. He would like to try his case management approach with managers cross-trained and working directly in the communities. Edgar's position is similar, calling community services more efficient: "The primary role for expanded services will come at the local level."
One other question, marginally a human service issue, points to differences in the two candidates. Hartigan supports the Family Leave Bill vetoed by President Bush and the Illinois version awaiting a promised veto by Gov. Thompson. Edgar opposes both the federal and state legislation.
The Illinois legislation, which has been pushed by the Illinois AFL-CIO, would allow workers at companies with at least 50 employees to take up to eight weeks of unpaid leave to care for a sick child or other family member. "If I were governor, I'd sign it," Hartigan says. The Democratic candidate sees the Illinois legislation as a way for government to express its support of family values, but he says he would support provisions that would ease business concerns, for example, over losing a key employee.
Edgar says that although he has a paid family leave in the secretary of state's office for new parents, he believes the area is best left to business and its workers. He fears that Illinois businesses could be put at a disadvantage compared to those in other states: "I get nervous when I hear the business community say this is going to hurt us; even businesses that have it say, 'we don't want it dictated by the state.' "
Hartigan: '. . . with prenatal care and postnatal care, then for every dollar you spend there, . . . the estimate is that you save three. . .'
Edgar and Hartigan share many positions in human services. Both would stress preventive services, particularly in health care. Both would emphasize community-based services. And both want to see a work component in state welfare programs.
There are major, but predictable differences. Republican Edgar says Illinois does well and could do better. But he says the lack of money precludes major program expansions and proposes reallocation and streamling of paperwork. Edgar is reluctant to impose requirements on business. In short he acts like a Republican, albeit more centrist than conservative.
Democrat Hartigan condemns current Illinois human services and would revamp the system. He would pay for expansion with cuts in the state bureaucracy. Hartigan says if the cuts did not provide the needed money, he would raise taxes. In short he acts like a Democrat, albeit more centrist than liberal.
Neil Hartigan on human services
"I think that we are so overwhelmed by the bureaucracy that exists in the social services in the state that the people who are supposed to be served are oftentimes not receiving the services."
"I've always measured government by the human being on the other side of the table. That person, as opposed to the bureaucracy, is really the test of the effectiveness of government."
"Illinois is the equivalent of Mississippi in infant mortality."
"I also absolutely will not accept the fact that we can't do dramatically better. We did in the past."
"I think there has to be bold, dramatic and profound change."
"We're taking the most vulnerable people in our society and oftentimes the least trained people in our society and expecting them to be the most sophisticated consumers in our society to try and get access through this maze."
"We've accepted this mess because we can't cure it? I don't buy it. Human beings messed it up. Human beings can unmess it."
"The more you personalize government and the more you figure out how you like to be treated by government, the better chance you have of having a government that actually functions like it should."
"We had better reform our thinking on our accounting. We need a whole new kind of accounting in government. There's the cost of doing things and the cost of not doing things, and in business it's called the lost opportunity cost."
24/August & September 1990/Illinois Issues
Neil F. Hartigan, Democrat for governor
After years of waiting in the wings, Atty. Gen. Neil F. Hartigan, at age 52, is making his run for the highest office in Illinois. Hartigan had run briefly for the Democratic gubernatorial nomination in 1986 before, in the name of party harmony, abandoning his campaign in favor of Adlai E. Stevenson III.
Neil F. Hartigan
A lifelong resident of Chicago's Rogers Park neighborhood, Hartigan was graduated from Georgetown University in Washington, D.C., with a bachelor's degree in 1959. He received his juris doctor's degree from Loyola University College of Law in 1962. Hartigan is married to Margaret (Marge) Dunne Hartigan. The couple has four children: John (26), Elizabeth (25), Laura (23) and Bridget (20).
On their 1989 income tax return the Har-tigans reported $81,615 in adjusted gross income, nearly all of it from his state salary as attorney general. The couple paid $12,328 in taxes on their income. The largest itemized deduction was $17,703 in mortgage payments on their house.
Upon completion of law school Hartigan worked for 10 years for the city of Chicago, starting as an administrative assistant to Mayor Richard J. Daley. In his tenure in Chicago he served as the city's legislative counsel in Springfield. Hartigan was also attorney for the Chicago Board of Health and general counsel for the Chicago Park District.
In 1972 Hartigan won the Democratic lieutenant governor primary, besting Democratic guhernatorial nominee Daniel Walker's hand-picked running mate, Neil F. Eckert, nearly two to one. Walker and Hartigan won in the general election, making Hartigan, at age 34 , the youngest lieutenant governor in the nation. Following his election Time magazine named him as one of 200 future leaders of the country.
Hartigan won renomination in 1976, but Walker did not. In the general election the ticket of James R. Thompson and Dave O'Neal bested the Democratic team of Michael J. Howlett and Hartigan.
Hartigan moved to the private sector. He served as president of Real Estate Research Corp., a firm that analyzed the real estate market for other businesses. Next he became senior vice president for international banking for the western hemisphere with First National Bank of Chicago.
He returned to public life in 1982, winning election as Illinois attorney general. In 1986 Hartigan campaigned briefly for the Democratic nomination for governor. When Stevenson entered the race Hartigan backed off and ran again for attorney general, saying he intended to avoid a divisive primary battle. He led all Democratic candidates for state constitutional office in that election confused by Lyndon LaRouche backers who won nomination as Democrats to two executive offices.
Hartigan maintains that his service in local and state governments, together with his private sector experience, gives him unique qualifications to serve as governor.
Hartigan says that as attorney general he has worked to make his office more accessible to Illinoisians. He set up 18 regional offices and nearly 300 satellite offices around the state, making the office more accessible to citizens. He characterizes the office as a "profit center" that returns five dollars to the state for every dollar spent.
And he claims that he has streamlined the office and made it more efficient. A management study that he had commissioned to modernize and computerize the attorney general's office has formed the basis of his campaign for governor. He argues that the same sort of business approach to government could be applied to agencies under the governor.
He cites several accomplishments as indicative of what he could do as governor. As lieutenant governor he helped create the Department on Aging, the first cabinet-level department for senior citizens in the nation. Hartigan says he approached a pair of Rhodes Scholars and offered them the chance to work on a project. Hartigan says that surveys showed that there were 43 programs in 24 agencies for senior citizens.
Hartigan similarly cites efforts that led to the creation of the Comprehensive Health Insurance Program (CHIP). Hartigan says that to win approval of the measure that provides state subsidized insurance for the uninsurable he brought together parties that had feuded for years, namely doctors, lawyers and elements of the disabled community.
Hartigan also cites:
Passage of the Crime Victim's Bill of Rights.
Formation of the Hazardous Waste Task Force in 1983 which produced 14 laws to fight hazardous and toxic waste.
Creation of the Disabled Persons Advocacy Division within his office.
Passage of the Illinois Grain Insurance Act and creation of the Agricultural Law Division within his office.
Expansion of the Consumer Protection Division of his office by hiring advocates to serve as mediators for consumers.
Intervention on behalf of consumers in all major utility rate cases.
Michael D. Klemens
August & September 1990/Illinois Issues/25