Editor’s Column – August 2011

The state shutdown was truly a catastrophe. Although disappointing, Gov. Dayton made the right decision. He did what had to […]

The state shutdown was truly a catastrophe. Although disappointing, Gov. Dayton made the right decision. He did what had to be done to get the state back to work, even though he knew he was accepting a budget that will not solve any of our financial woes but only put them off for another budget cycle. There are a couple things we can be grateful for, and you can read all the details on those throughout this issue. But most importantly, our state is back up and running and our state workers are back on their jobs.

Some of the bad news in this compromised budget: occupational, physical and speech therapy for adults 20 and over was drastically cut; the 20% cut in wages for relatives who work as PCAs remained in the budget bill; and reduction in reimbursement rates to PCA providers will still go into effect. There is also a 4.5% cut to non-emergency medical transportation— meaning your ride to the doctor will cost more.

The shutdown was really an expensive political maneuver or experiment. It was very expensive to shut down and equally expensive to get the state back up and running again. I hope it will be very costly for the elected officials that refused to compromise. It’s our obligation to make it expensive to them; we have to take it upon ourselves to make sure that like-minded people are elected to govern. At the very least, we have to have people who are interested in our society as a whole, not just in the welfare of people like them. The shutdown raised many questions about the fundamental obligation of government to its citizens.

What makes a service essential? Who and what determines what is essential to the citizens? Thomas Hobbes (1651), John Locke (1689) and Jean-Jacques Rousseau (1762) are the most famous “social contract” thinkers, and their work had a deep effect on the writers of the US Constitution. Each drew quite different conclusions about the nature of political authority or obligation, and during the lives of these philosophers, medical necessity was not part of their thinking about the social good. But their theories all held that government has an obligation to its citizens to provide liberty and safety. What is the definition of safety? Is providing medically necessary services and ensuring citizens’ independence a matter of liberty and safety? This is a question that should be at the heart of the debates of our elected officials.

During the state shutdown with issues of medical necessity involved, the courts were forced to decide what essential services are (or the social contract is). How is it then that the legislature could cut appropriations to deliver effectively what the court has determined are essential services? It seems to me that there are some constitutional legal questions related to some of these cuts. That might be also why Ramsey County Chief Judge Kathleen Gearin was so careful about making some of the rulings she was obligated to make about the state’s essential services.

When our good friend, Luther Granquist, a retired lawyer, wrote me about his history note this month, he explained to me (now what follows is in Tim terms) how in October 1974, Judge Larson ruled in Welsch v. Likins, a class action involving Cambridge State Hospital that the “due process” clause of the State Constitution required increased staffing levels at Cambridge. Not being a lawyer, I became even more confused. I was thinking that government’s ‘social contract’ would explain its fundamental obligation, but in this specific case it was the constitutional guarantee of the “due process” of law. Because individuals at Cambridge were court-ordered to be in state custody, the state was required to provide them with the necessities to remain clean, healthy and safe, and with the appropriate staffing to ensure these services.

It seems so clear that we as a society have to address some fundamental questions and concerns about obligation. In the history note you will read about a situation in which another court required the state to adequately fund services to people who were institutionalized. (It is an interesting read; please do take the time.) It also illustrates the issue of government’s obligation to meet the security and liberty necessities of all individuals. For many of us, it raises the further question about the needs of those who are not institutionalized but living in the community.

This is where action comes in. If we’re going to answer these questions and prevent these standoffs of opposing views, we must become politically involved in getting officials elected who have similar philosophies on the obligation of government to its citizens—especially those who are disabled, elderly, or not completely capable of being independent. Remember, the ADA requires that people with disabilities live in the least restricted environment. This is our right! Let’s keep protecting that right and keep reminding society and legislators.