Journal of Community Health Vol. 1, No. 3, Spring 1976
EDITORIAL
HERE WE GO AGAIN[
Recent health planning and resource legislation has been hailed as a milestone by s o m e - a n d as a millstone by others. The efforts to overcome the failures of Regional Medical Progams and Comprehensive Health Planning by pooling their impotence raises the question of whether the lawmakers are putting new teeth into health planning-or merely supplying feeble planners with a set of dentures. A portion of PL93-641 calls for the establishment of centers to provide technical assistance and training to the staffs of the several levels of health planners set forth. One can almost hear the gears whirring as educational institutions and consulting firms begin to respond. Old training manuals are dusted off, new flip charts ordered, transactions analyzed. It is another round of technical assistance, with advisory groups convened. We would say to the federal folk who are responsible for this, "Fie on y o u ! " We have blamed the System for poverty, for ill health, for inflation, and for pollution. Should we not condemn the system for reducing our intellectual health leadership to such a state? What is it that would cause such clever people to behave in such a way? How can the educators who bemoan the futility of transforming the failures of a school's admissions committee into a cohort of gifted graduates turn around and train political appointees? How does one reconcile a faculty who urge that problem identification precede solutions with those ready to provide technical assistance for problems no one understands? How can the same groups who urge meaningful consumer participation in health care delivery fail to involve their consumers in health care planning assistance? So many of us have at one time or another had to suffer with technical assistance consultants who knew less of the field than we did and nothing about the specific problem. Have our sufferings gone for naught? Have not We learned that it may be wiser to delay offers of assistance until we understand the problem and have something to offer? Might it not be wiser to give the funds intended for these resource centers to the various Health Systems Agencies (HSAs), demand more from them, and let them buy help when they need it? At the same time one would, of course, have to make clear what was expected of the HSA and be prepared to call upon additional resources in case of failure. But technical assistance must be tied to the performance requirements of the HSA. 161
162
JOURNAL OF COMMUNITY HEALTH
Perhaps a very few special centers might be created to continue our efforts to understand and master the planning process. Innovations tested here could then be shared more widely. Why should we encourage competition and parallel activities in the various centers? Simultaneous discovery is not efficient and may be demoralizing. Is it not time then that we called u p o n federal policy regulators to lead us n o t into t e m p t a t i o n by forcing upon us centers that threaten to rekindle the exploitations of old? Robert L. Kane, M.D.
EDITORIAL
HERE WE GO AGAIN[
Recent health planning and resource legislation has been hailed as a milestone by s o m e - a n d as a millstone by others. The efforts to overcome the failures of Regional Medical Progams and Comprehensive Health Planning by pooling their impotence raises the question of whether the lawmakers are putting new teeth into health planning-or merely supplying feeble planners with a set of dentures. A portion of PL93-641 calls for the establishment of centers to provide technical assistance and training to the staffs of the several levels of health planners set forth. One can almost hear the gears whirring as educational institutions and consulting firms begin to respond. Old training manuals are dusted off, new flip charts ordered, transactions analyzed. It is another round of technical assistance, with advisory groups convened. We would say to the federal folk who are responsible for this, "Fie on y o u ! " We have blamed the System for poverty, for ill health, for inflation, and for pollution. Should we not condemn the system for reducing our intellectual health leadership to such a state? What is it that would cause such clever people to behave in such a way? How can the educators who bemoan the futility of transforming the failures of a school's admissions committee into a cohort of gifted graduates turn around and train political appointees? How does one reconcile a faculty who urge that problem identification precede solutions with those ready to provide technical assistance for problems no one understands? How can the same groups who urge meaningful consumer participation in health care delivery fail to involve their consumers in health care planning assistance? So many of us have at one time or another had to suffer with technical assistance consultants who knew less of the field than we did and nothing about the specific problem. Have our sufferings gone for naught? Have not We learned that it may be wiser to delay offers of assistance until we understand the problem and have something to offer? Might it not be wiser to give the funds intended for these resource centers to the various Health Systems Agencies (HSAs), demand more from them, and let them buy help when they need it? At the same time one would, of course, have to make clear what was expected of the HSA and be prepared to call upon additional resources in case of failure. But technical assistance must be tied to the performance requirements of the HSA. 161
162
JOURNAL OF COMMUNITY HEALTH
Perhaps a very few special centers might be created to continue our efforts to understand and master the planning process. Innovations tested here could then be shared more widely. Why should we encourage competition and parallel activities in the various centers? Simultaneous discovery is not efficient and may be demoralizing. Is it not time then that we called u p o n federal policy regulators to lead us n o t into t e m p t a t i o n by forcing upon us centers that threaten to rekindle the exploitations of old? Robert L. Kane, M.D.
