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Aughie and Nia move on to the next department in the series, the Department of Health, Education and Welfare, later the Department of Health and Human Services (HHS).
This podcast uses government documents to illuminate the workings of the American government, and offer context around the effects of government agencies in your everyday life.
Welcome to Civil Discourse. This podcast will use government documents to illuminate the workings of the American Government and offer contexts around the effects of government agencies in your everyday life. Now your hosts, Nia Rodgers, Public Affairs Librarian and Dr. John Aughenbaugh, Political Science Professor.
Nia Rodgers: Hey, Aughie.
John Aughenbaugh: Good morning, Nia. How are you?
Nia Rodgers: I'm good. How are you?
John Aughenbaugh: I'm always, thank you.
Nia Rodgers: Yeah.
John Aughenbaugh: Yes.
Nia Rodgers: This week's episode, we're talking about a particular department.
John Aughenbaugh: Yes.
Nia Rodgers: Can I just give the initials of the department? They make me so happy.
John Aughenbaugh: Yeah. Go ahead.
Nia Rodgers: HEW, H-E-W. You know why listeners you have not heard of HEW because it doesn't exist anymore.
John Aughenbaugh: No, it does not.
Nia Rodgers: But that's the original name of Health and Human Services, HHS or HHS was HEW, The Department of Health, Education and Welfare. I did not realize how much stuff is in this department. We talk regularly about how departments, people are like, "I don't know, put in commerce. I don't know, put it in interior." They just cram things. This feels like a department that was crammed together.
John Aughenbaugh: Nia, I get this a lot from students, because I teach classes like public administration and bureaucratic politics. Students will ask, what's the broad purpose of x department but this one.
Nia Rodgers: What's the broad purpose of, oh my.
John Aughenbaugh: Of Health and Human Services. On one hand, as you just pointed out, there are a lot of different agencies within this department. On the other hand, this is one of the easier ones to answer when I do get asked, because it is the department that probably best represents the American federal government commitment to welfare, to the infamous safety net.
Nia Rodgers: That makes sense to me with what's in this department.
John Aughenbaugh: We don't talk about that all that much here in the States. If you go to Western European democracies, compared to the United States, made a commitment to providing a safety net, or what's known by scholars as the Welfare State, much earlier than the United States. Even today they spend more money and they make more of a commitment. We could probably do another podcast episode of the pros and cons of that commitment versus the United States. But if you look at the agencies within Health and Human Services, first of all, the Food and Drug Administration used to be part of the precursor to HHS.
Nia Rodgers: Can we just say to listeners, we're not going to try to differentiate too much between HEW and HHS?
John Aughenbaugh: Yes. We will get to the history in just a couple of moments. But for our purposes, because we basically only have roughly an hour, Health Education and Welfare begat Health and Human Services.
Nia Rodgers: Department of War begat the Department of Defense, but it didn't really change purposes all that much.
John Aughenbaugh: We reconfigured it. Maybe there are different points of emphasis. But in this particular podcast episode, listeners, when education gets removed in the 1870s to become a standalone department. Health and Human Services, its focus really became narrow in regards to providing a safety net.
Nia Rodgers: It's interesting, they changed welfare to Human Services in part because welfare has a reputational issue. That word has a reputational issue.
John Aughenbaugh: Historically in the United States, welfare has a negative connotation. You don't want to go on welfare if you're an individual. According to many Americans, even today, the fact that there are hard-earned taxpayer dollars are being used for "welfare" still burns them, upsets them.
Nia Rodgers: Although they very much like the things that come out of these programs. Because the other things that you're going to mention, Food and Drug Administration, which by the way, keeps you from dying of ingesting things that are terrible for you.
John Aughenbaugh: Now that's a standalone Independent Regulatory Commission, but the FDA used to be part of it. Indian Health Service, Native American Health Service, the Centers for Disease Control, that's still part of HHS, Medicare, and Medicaid. For our younger listeners, Medicare is the health insurance program for the elderly and the retired.
Nia Rodgers: Because they don't have it through their work, that the government provides something to help with insurance needs like medication coverage and medical care coverage and things.
John Aughenbaugh: Doctors visits etc. Then Medicaid, which is the health program for the poor. Social security until 1995 was part of HHS. We'll talk about that removal in just a few moments. The bulk of the implementation of the Affordable Care Act, otherwise known as Obamacare, was placed in HHS. Head-start, which Nia and I have talked about in a previous podcast episode, that's the food and nutritional program for children at school. That's part HIPAA, which we did an entire podcast episode on.
Nia Rodgers: That's right.
John Aughenbaugh: Every one of these department episodes we do I learn something new. I did not know the federal government's foster care program was part of HHS.
Nia Rodgers: I guess that makes sense because that's the welfare of children. That's looking after children who had been either removed from their homes or who have had parents die or what have you and how do we care for those children? Boards of the state as it were. How do you make sure that they're cared for?
John Aughenbaugh: Maybe part of my knowledge deficit, Nia was that historically, foster care has always been provided either at the state level of government or by non-profit organizations.
Nia Rodgers: Churches. Used to be a lot of Churches took care of children who did not have parents or whatever reason. I didn't know that either until I saw it on your list. I'm like, but that makes sense when you consider the overall mission of the department is human welfare. It is how do we care for the elderly and the poor and children, like what we think of as the weakest in our society in terms of people who can take care of themselves. How we make sure that those people are cared for. Because otherwise, we're an inhuman bunch of jerks who say, "Old people, who needs to take care of them? Who cares about kids?" We don't want to be those people.
John Aughenbaugh: That's a cultural tension in the United States compared to other nation-states.
Nia Rodgers: Well, we want to take care of those people, but we don't want to pay for it. Which is like, how is that supposed to work?
John Aughenbaugh: We're very individualistic in the United States. That's hard-wired into American political culture. But we also don't have, in other nation-states, I'm thinking about Japan, a culture of where families take care of their elderly.
Nia Rodgers: We had that up until we stopped being as agrarian and people moved into cities. There's less of that now. Now you need a retirement system for people who are no longer living with family members.
John Aughenbaugh: Yes.
Nia Rodgers: To be cared for. Who started it? Which administration is department of?
John Aughenbaugh: Interestingly enough, the first presidential administration who proposed this department was Warren G. Harding in 1923. Again, I didn't know this in part because when I think of the Harding Administration, I think about all of the corruption and scandal. But he proposed a Department of Education and Welfare. It got absolutely no traction during the Gilded Age of the 1920s.
Nia Rodgers: When people didn't need that. They didn't need to be taken care of.
John Aughenbaugh: The next time we get a proposal was a Federal Security Agency which was part of a White House reorganization during the Franklin Delano Roosevelt administration. The purpose there was not necessarily welfare, it was just to go ahead and bring together in one agency, various federal government programs. Remember listeners, during the 1930s, FDR was requesting and Congress was creating a whole bunch of these.
Nia Rodgers: The government grew mushrooms in a field.
John Aughenbaugh: They get to the end of the decade, and many within Congress, but also the Roosevelt administration was like we might want to go ahead and organize to use your metaphor, all of these mushrooms.
Nia Rodgers: Put all the similar varieties together, put them all in one part of the field.
John Aughenbaugh: What they created was a federal security administrator. I love his last name, Paul McNutt, to bring together agencies concerning health, education, and social security.
J. Aughenbaugh: It was a very small agency, because all they had was an administrator's office of Public Health Service, an Office of Education, the Triple C Civilian Conservation Corps, and the Social Security board. Pretty minor. Interestingly enough, Health, Education, and Welfare as a department actually occurred as part of President Eisenhower's Reorganization Plan Number 1 of 1953.
Nia Rodgers: It takes 14 years for this to become.
J. Aughenbaugh: A full-blown cabinet department. By the way-
Nia Rodgers: Do you think that because in part because it was growing as like all of those sections within were getting bigger and somebody said, we want to make that a level department?
J. Aughenbaugh: Well, part of it was, those units that I just mentioned. All expanded post-World War II. We learned a lot about public health because of how we treated wounded soldiers during the war.
Nia Rodgers: That makes sense.
J. Aughenbaugh: Those security which was only supposed to exist for three years. Well, by the 1950s, it had existed for nearly 20 years.
Nia Rodgers: People who depend on it there was-
J. Aughenbaugh: It wasn't going anywhere. This is the only department Nia in our country's history created through presidential reorganization or authority.
Nia Rodgers: Really.
J. Aughenbaugh: Congress gave Eisenhower the authority because he asked for it. One of the things he was noted for when he was an Army General was, the dude could organize and plan.
Nia Rodgers: Yes.
J. Aughenbaugh: Think about it. D-day.
Nia Rodgers: I was going to say, wasn't he responsible him and Churchill for the D-day?
J. Aughenbaugh: D-day.
Nia Rodgers: Right. He could plan a thing. I'm just saying.
J. Aughenbaugh: He could plan a thing. He gets from Congress.
Nia Rodgers: This is the guy you want to be your wedding event planner?
J. Aughenbaugh: Yes.
Nia Rodgers: Just saying. He would an answer for everything.
J. Aughenbaugh: Yes. You decide to go ahead and have a party in your backyard.
Nia Rodgers: You need a barbecue. I need Eisenhower to run this barbecue. But I do have a question about that.
J. Aughenbaugh: Yes.
Nia Rodgers: DHS was not created by a president?
J. Aughenbaugh: No. Remember Nia, only Congress has the authority to authorize new agencies.
Nia Rodgers: For some reason, I was thinking that came out as a reorganization. I feel certain President Bush asked for it.
J. Aughenbaugh: Well.
Nia Rodgers: We need a reorganization where we have some stronger-
J. Aughenbaugh: But think about the creation of the Department of Homeland Security. The 9/11 attacks occurred, the first thing that Bush did was he created a director, a czar-like position Tom Ridge, former governor of Pennsylvania, but he had no agency to run.
Nia Rodgers: That's what I'm thinking of. Sorry. That's what I'm thinking. I'm just like wait, but there were people I remember Ridge and there's the other guy, Michael.
J. Aughenbaugh: Chertoff.
Nia Rodgers: No, Clark.
J. Aughenbaugh: Well, yeah, that's right.
Nia Rodgers: I see you can create a czar, but that doesn't give it a department.
J. Aughenbaugh: That's right. He could convince Congress to-
Nia Rodgers: To give it a department.
J. Aughenbaugh: To create a department and then allocate the money. That's the big thing. But this is the only time because Congress gave Eisenhower this broad sweeping reorganization of the executive branch of power, and this is the only cabinet department ever created by a president using reorganization authority given to the President by Congress, the only time.
Nia Rodgers: Can I say that one of the coolest things that comes out of this is the CDC, and prior to the CDC or in parallel with the CDC is the community public health program?
J. Aughenbaugh: Yes.
Nia Rodgers: That makes sense to me that the federal government would say, we need to have some federal standard for public health. That it can't be that one city has great public health and another city doesn't because it's left at just the local level and it depends on state funding.
J. Aughenbaugh: That does reflect that constitutional construct known as federalism.
Nia Rodgers: Something that you talk about on a pretty regular basis, cooperative federalism.
J. Aughenbaugh: Federalism, yes. Because when this department was created, this is great. I found this in the research and I'm like, I love this stuff. When Health Education and Welfare was created, one of the first programs it initiated was community public health, and they gave grants to cities. It wasn't like there were federal officials they came into cities and said, you now need to go ahead and create these public health programs just like this. No, they gave money to cities and told them, when you receive the money, we want you to use the money for these purposes. Of course, cities and states aren't always keen about the conditions placed on the money, but they want the money. In Chicago took their public health program money and they used it for rat control. Because Chicago for decades had problems with rats.
Nia Rodgers: Right. It's a serious public health issue.
J. Aughenbaugh: Because rats carry all kinds of disease.
Nia Rodgers: Even though they've gotten probably, it's probably incorrect that they carry bubonic plague. At this time in history, people thought they did, but they also just carry normal diseases that are gross and bad for you.
J. Aughenbaugh: That's one of those things that our colleague Judy Twig talks about. When human beings interact with animals, it's not always good for either party.
Nia Rodgers: Now, what I want to imagine, I know this is not what happened, but I want to just visualize this for just a moment with our listeners. I would like to believe that what they did for rat control was they went out and bought a bunch of cats. The whole city in this case. You know what I mean? A little old ladies in Chicago put out food for the cats and then the cats would chase rats, I'm just saying. But they also did stuff like municipal waste, that idea of when humans all live together, we need to have good sanitary practices otherwise we all end up sick.
J. Aughenbaugh: It because there's frequently a lack of will by local and state politicians to raise taxes to create programs to address these collective problems. It's a problem with the collective as you just described, Nia. You throw millions of people into a small area and it becomes densely populated.
Nia Rodgers: The next thing that breaks out is cholera.
J. Aughenbaugh: Problems occur. Because you need to go ahead and give them clean drinking water, but keep it away from the water that's used for solid waste.
Nia Rodgers: And the solid waste needs to have a place to go.
J. Aughenbaugh: That's right.
Nia Rodgers: Because otherwise, you get the streets of London in the 1700s.
J. Aughenbaugh: Yes. How do you have sanitary landfills instead of just dumps?
Nia Rodgers: But my favorite is the radiation program under which it wrote standards on things like microwave ovens. For the first time in history, you have radiation being used by households, so you need to have standards because if you don't, radiation in too much or in the wrong way, is extremely bad for your physical well-being.
J. Aughenbaugh: Because those of us today who know microwave ovens as an essential appliance.
Nia Rodgers: I don't have one, but a lot of people do.
J. Aughenbaugh: Well, hey.
Nia Rodgers: How do you rewarm coffee for the eighth time if you don't have a microwave?
J. Aughenbaugh: Or for that matter, if you have any children. But think about what probably happened when they first created microwave ovens. You know there were some genius inventors who are like, well, we can go ahead and cook a 16-ounce T-bone in this microwave and 35 seconds, and they just blasted the heck out of it in unhealthy amount of radiation.
Nia Rodgers: Exactly. That also because you're standing in front of it, watching it, gets you, gets the stake then you consume it and you get more. We like the idea of community public health, and we'd like it because we don't think about things like most people, when they go to the restroom and they flush the toilet, they don't think about where that goes or how it doesn't affect drinking water, it doesn't affect groundwater, it doesn't affect plants in the local area. They don't think about that because of this kind of program where the government comes in and says, we're just going to take that off your plate., you don't have to think about how all of that works. It's just going to magically disappear because we're going to build systems that take it away. Then when it fails, Allah Flint, and you get people who can't drink the water.
J. Aughenbaugh: Yes.
Nia Rodgers: That wasn't because of fecal matter, that was because of iron. I think it was because of the. Tubes that the water was carried in. Right?
J. Aughenbaugh: Poor pipes. They never updated the pipes that brought in drinking water.
Nia Rodgers: That's something that this kind of thing would address.
J. Aughenbaugh: Yes.
Nia Rodgers: Except now it's under the EPA, and it's under the EPA because we don't have the EPA in the 1850s. We don't get the EPA until Nixon, which I think again, we talked a lot about President Nixon's foibles, and low there are many. But he also did something like he created the EPA.
J. Aughenbaugh: I'm not going to belabor this point all that much. But Nia, you've heard me say this in a number of forums. I want you to take note of the fact that we get Health Education and Welfare under a Republican presidential administration. We get the EPA under Republican administration.
Nia Rodgers: Yeah, they'd be drummed out now.
J. Aughenbaugh: Yeah, listeners do you understand that-
Nia Rodgers: Republicans would want nothing to do with some of what this-
J. Aughenbaugh: Political parties evolve and change.
Nia Rodgers: Exactly.
J. Aughenbaugh: You know, the Republican Party of the 1850s. Even well into the 1970s and 80s, actually did believe that government could do some good things, particularly on the collective level.
Nia Rodgers: Right.
J. Aughenbaugh: I mean, because, you know, in part and I've read enough about, for instance, why Nixon wanted the EPA. Nixon thought that if we had an Environmental Protection Agency that worked with business, then the costs of environmental regulations could be manageable. The thinking was, yes, we can go ahead and clean up the environment, but we can do so in a way that we're not necessarily harm or imposed egregious costs on business. But that's a thinking that today in polarized United States, where liberals would go ahead and say, who cares about the costs, we need to go ahead and address climate change. Then you have conservatives who are like, well, I don't even believe climate change exists. Then there's a whole bunch of us who are like, isn't there a middle ground?
Nia Rodgers: Right. Can there be a place where we handle things but we handled it moderately? I think that it should be probably if you haven't figured this out by now, Aughie and I are both probably falling into more of the moderate category of almost everything. We're like, can't we just work something out here? There are a few things where I'm a die-hard nope, there is a line in sand.
J. Aughenbaugh: Yes.
Nia Rodgers: For instance, for me, Ukrainian sovereignty is a line in the sand.
J. Aughenbaugh: Yeah.
Nia Rodgers: No part of Ukraine should belong to Russia because Ukraine is it's country. But that's because I believe in sovereignty, and I don't think you should just go around snagging other. Because otherwise we would take the good parts of Canada and leave the rest, and the Canadians would not like that at all.
J. Aughenbaugh: You just mentioned the North. I'm thinking there are parts of our federal government who would not necessarily mind another Mexican land grab.
Nia Rodgers: That's right.
J. Aughenbaugh: I mean we did it once in the 19th century.
Nia Rodgers: Not so much with that like hard lines, but for the most part, I also think that a lot of things can be negotiated, and I think they should be negotiated. I think we should be more moderate and it should not be nearly as polarized as it is. However, that is an aside that has nothing to do with the fact that I would imagine that this department exploded under the great society.
J. Aughenbaugh: Yes.
Nia Rodgers: Because LBJ's whole point of view was we need to not have poor people. We need to not have uneducated people, everybody in the United States has the right to a decent education, to decent living conditions.
J. Aughenbaugh: I have listened to the audio of a speech that he gave to the United States Congress, where President Lyndon Baines Johnson spent five min talking about running water and indoor plumbing.
Nia Rodgers: Right. Because the part of Texas that he came from, was extraordinarily poor and he was a principal in a very poor school.
J. Aughenbaugh: Yes.
Nia Rodgers: He wanted those folks to have a chance to improve their lives, which is generally done through education and standard of living.
J. Aughenbaugh: Yes. As you just pointed out, Health Education and Welfare grew dramatically during the Johnson administration. First you get Medicare. Think about this, Nia. Before Medicare, there was no health insurance program guaranteed to the elderly and retired Americans.
Nia Rodgers: Yeah, if you get sick, that's just too bad.
J. Aughenbaugh: Medicaid.
Nia Rodgers: In the 1960s you're seeing people live longer. You're starting to get medicine that is extending people's lives longer than say in the 20s when this first came up as a question and died out was because people are living longer.
J. Aughenbaugh: Think about this. After World War I and World War II, where the United States lost a significant part of its younger population, life expectancy jumped dramatically in the 1950s and 60s. Before the Vietnam War, I mean, you have a decade of post-World War II growth in quality of life changes in the United States. You're looking up life expectancy, aren't you?
Nia Rodgers: Actually what I'm looking up is in 60s when we get wide use of penicillin. No, it's the 40s when we get wide use of penicillin. It's the war where we start learning to save lives through the clever use of chemistry.
J. Aughenbaugh: Yes. Well, what is it? We don't get the polio vaccine into what? The 1950s.
Nia Rodgers: Right, sock. Then you're again seeing life expectancy, and not just expectancy, but also longer periods where you will be healthy but then longer periods where you are not as healthy.
J. Aughenbaugh: Yeah.
Nia Rodgers: You don't deteriorate as quickly because now there are ways to prolong or to prevent the deterioration as quickly.
J. Aughenbaugh: Yes. You get Medicare then you get Medicaid.
Nia Rodgers: How are we going to take care of our poor?
J. Aughenbaugh: That's right.
Nia Rodgers: They get sick too, turns out.
J. Aughenbaugh: Well, and because of lifestyle variables. They live in poor neighborhoods with more crime.
Nia Rodgers: Fewer amenities.
J. Aughenbaugh: Fewer amenities. They have less money to go ahead and buy healthy food. Let's face it. To eat healthy at times cost more money than to eat poorly.
Nia Rodgers: Yeah. Then you get the sheer cost of going to the doctor.
J. Aughenbaugh: Yes.
Nia Rodgers: You get limited medical facilities in certain communities.
J. Aughenbaugh: Yes.
Nia Rodgers: Which is also going to.
J. Aughenbaugh: Then the big one. This is the pivot point in our discussion of Health Education and Welfare. LBJ convinced Congress to pass the Elementary and Secondary Education Act in 1965. Now, again, its broad purpose was to get a whole bunch of federal money into communities that had poor public schools. But this is another example of cooperative federalism. For you to get that money, you had to show that you were desegregating your public schools. This is a standard feature of cooperative federalism. Federal government creates a program, allocates a whole bunch of money, says to states, local governments, do you want some of this cash? Of course, they're like, yes we do. Then the Fed say, but there are certain strings attached. That was one of the biggest strings with the Elementary and Secondary Education Act. You get desegregation, according to some scholars, because of this law, it was great that the Supreme Court said that segregation was unconstitutional, in Brown versus Board. But when the United States Congress backs that up a decade later with millions of federal dollars.
J. Aughenbaugh: A whole bunch of states were like, okay, sure, we'll go ahead and treat our students of color better because they wanted what? Money.
N. Rodgers: Right.
J. Aughenbaugh: They wanted money. But those issues is what led to in 1979. Those are some of the issues that led to, not all of them, but some of the issues that lead to education being removed from this department and becoming a standalone cabinet department during the Carter administration. At that point health education and welfare becomes health in human services.
N. Rodgers: Right, and we see the change from welfare to human services
J. Aughenbaugh: Yes, and it's a sprawling department, Nia.
N. Rodgers: It covers all the things.
J. Aughenbaugh: It has a secretary, a deputy secretary, seven assistant or under secretaries. They have 10 regional offices. Basically the United States is divided into these 10 regional offices. Each of the regional offices, as a director with under directors or assistance directory.
N. Rodgers: Good grief. I work for a guy who works for a guy who works for the secretary of the department.
J. Aughenbaugh: I've said this a couple times, we've both have said this a couple of times during this podcast episode. It's a really good example of cooperative federalism because almost all of health and human services money is passed through the regional offices on the way to what final destination?
N. Rodgers: To the state and local agencies. I'm assuming that in part, that's because distribution of those services is best done at the state level.
J. Aughenbaugh: Yes.
N. Rodgers: But funding of those services is best done at the federal level.
J. Aughenbaugh: Federal level, yes.
N. Rodgers: We take everyone's tax dollars and we divide them out accordingly and then we give the states a certain amount of money. Because otherwise, and maybe I'm wrong. Aughe, please correct me if I'm wrong. But if Wyoming had to only fund Wyoming's stuff, there would be a lot less stuff in Wyoming because there's a lot fewer people to fund it. Or they'd say something like and your tax bill is $32,000 this year.
J. Aughenbaugh: Yeah.
N. Rodgers: Like it would be outrageously. But what you do is you take the population, the large populations, and you nibble off a little bit from them and you give it to Wyoming so that the people in Wyoming who need Medicare or Medicaid can get those programs without the state having to come up with an unbelievable amount of money per individual. I'm I more or less?
J. Aughenbaugh: You've captured easily two or three of the variables related to bureaucratic politics and public policy implementation. So many of these programs in HHS or redistributive programs. You're basically taxing Americans, middle-class and upper-class Americans and redistributing that wealth to the elderly, the retired, poor people.
N. Rodgers: Children.
J. Aughenbaugh: Children, people with chronic health conditions. You're redistributing that money. Now, if you did that at the state local level, the politics just doesn't support that.
N. Rodgers: Well, and the finance doesn't support that.
J. Aughenbaugh: Well, it neither. You've added the money, the budget element to all of this. But if you do it at the federal level-
N. Rodgers: Tiny little pain for everybody.
J. Aughenbaugh: Yes.
N. Rodgers: Versus massive amount of pain for a few people.
J. Aughenbaugh: People within a particular state. Again, politics and states is definitely local.
N. Rodgers: If you said that my tax bill in Wyoming was $32,000, I would move.
J. Aughenbaugh: Yes.
N. Rodgers: That's what happens. Then you get plight for people trying to say that's too much money. But if everybody's tax bill is, let's just round it and say everybody's tax bill is $1,000, but it's everybody in the United States, and then it all gets distributed across then it's not so painful for any one individual, comparatively.
J. Aughenbaugh: In deed to your point, think about our discussion of the 2020 census and how some states lost people or their growth was not as great. We talked about, for instance, California. California has lost a significant number of people.
N. Rodgers: Yeah, people are getting up and leaving California.
J. Aughenbaugh: In part, if we are to believe the surveys of these individuals, many are leaving because of the tax burden, the quality of the services, etc.
N. Rodgers: Right.
J. Aughenbaugh: But again, you captured so much of why an agency like HHS can exist and function and deliver essential services even though intellectually or theoretically, a lot of Americans don't like these programs until-
N. Rodgers: They need this program.
J. Aughenbaugh: Until they need the programs.
N. Rodgers: Or somebody they love needs the program.
J. Aughenbaugh: Right.
N. Rodgers: That's when people are like, oh, I think that's a great program. Well, yeah, you think that now. But I do think there's an interesting economic question there, or rather there's an interesting discussion to be had and it should be fairly stated that-
J. Aughenbaugh: Redistribution.
N. Rodgers: Redistribution, I'm struggling with the word, of wealth is a complex political question.
J. Aughenbaugh: Yes.
N. Rodgers: There are nuanced arguments to be made on both sides. Folks who think that's a terrible idea, you have reasons for thinking that's terrible idea. They're not just, and so I want poor people to starve to death or whatever, that's not how that works. Sometimes I think that their reasons for saying that's a failure of the overall system, that's a failure of capitalism when we have to redistribute the wealth, then something's wrong in the system and we need to fix what's wrong with the system instead of fixing the symptom, which is unequal or lack of parody. Those people actually have an argument there. They're not just saying. I don't want to pay for that. They're also saying what's wrong with the system that we have to pay for that or that we have to-
J. Aughenbaugh: What is the best way?
N. Rodgers: Or how do we do this in the most fair and equitable way across a large number of people. There is a civil discourse to be had on that.
J. Aughenbaugh: Yeah. I hate the labels. They get placed on the ideas that are part of that debate. If you ask questions about, for instance, Medicare, it doesn't mean that you're anti old people. You might have some fundamental questions that you think need to be addressed. Likewise, just because you support Medicaid, doesn't necessarily mean that you're a warm hearted advocate for the poor. You might just prefer to go ahead and have the government go ahead and do what others believe should be done by individuals or community organizations.
N. Rodgers: I'll pay somebody else to do that.
J. Aughenbaugh: Yeah. Because you don't want to get your hands dirty and you don't want to spend your valuable time. Oh, really? If we have that discussion, and I've participated in some of them, I'll just like guys, let's dial back the rhetoric.
N. Rodgers: Nobody here wants to see old people or children starve or die in the streets. No one is evil here. People are just trying to think through the problems and are we solving for the right problem. Because if we're not, let's fix what's actually broken.
J. Aughenbaugh: If we're just focusing on the symptom, is that because we can only address the symptom because the problems are so complex and intractable.
N. Rodgers: Then stop yelling at each other about that. We just have to say, that's just a big giant problem that we can't unravel, but we're going to nibble around the edge and fix it.
J. Aughenbaugh: Instead of let's go ahead and try something out and see if it works before we go ahead and have a fundamental redirection, there's a lot of ways to cut this up.
N. Rodgers: Can we talk a minute about the controversies because you and I are discussing that now in vague sense. But there's some actual, real controversies. Can I mention? There are the tying federal education dollars to desegregation caused some counties in some states, Virginia, I'm looking at you, for their schools to close. They were like, you know what? We're not going to take your money. We're not going to take your money because we don't want to desegregate the schools. I have real questions about whether the federal government and it's something I sole-search and go back and forth on whether the federal government should be in charge of the moral questions like desegregating schools. That's a social issue. It's also a moral issue. You can't make people want to do that. They need to do that because it's the right thing to do and they come to that as a decent person. I don't know if you can buy decency. No, that's a complicated thing. But then again, if you don't do that, how do you force it on people who wouldn't do it on their own?
J. Aughenbaugh: Yeah. My students struggle with this, I even sometimes struggle with it. I mean, just to use an example that's unrelated to desegregation-
J. Aughenbaugh: There's the phenomenon known as the digital divide, where we have parts of the United States that have limited or no access to the Internet. Part of me thinks that is horrendous.
Nia Rodgers: But so much of life now is worked through the Internet or run through the Internet or what have you.
J. Aughenbaugh: People in those communities should have access to the opportunities that the Internet provides. On the other hand, the private sector has determined, and I can understand their perspective, that it's not cost-effective to go ahead and build out the Internet in a community that may have 75 people.
Nia Rodgers: The property that my parents live on, they have to use satellite in order to get cable. Because the cable company said, Oh, sure, we'll run the cable at your place, that'll be 9,000 dollars.
J. Aughenbaugh: Yes.
Nia Rodgers: My parents said, Well, we don't want to watch cable that much. They didn't get it. In fairness to the cable company, that's them digging up and putting down the line and doing the whole thing and maintenance it and all that other stuff. I get why they don't because my parents live way out from town.
J. Aughenbaugh: We have government programs in place today that provide financial incentives to convince Internet companies, to build out those lines, to build out their capacity. I know some people refer to that as corporate welfare. On the other hand, I'm like.
Nia Rodgers: How else would it get done.
J. Aughenbaugh: How else would it get done and we're basically telling poor rural people that the Internet age isn't for you.
Nia Rodgers: Or you should move.
J. Aughenbaugh: Or you should move.
Nia Rodgers: That's the other thing we're saying to them is, You should move from this place where you've lived for generations.
J. Aughenbaugh: I don't feel comfortable telling poor people in cities that if you don't like the schools, you don't like the safety of your neighborhood, well, move. I don't think we should be telling those people.
Nia Rodgers: We should fix the safety of the schools and the safety of the neighborhoods.
J. Aughenbaugh: I'm like, how do we do this? But one of the most effective ways, and I've had students refer to it as, but that's extortion.
Nia Rodgers: Sometimes the federal government threatens to break your kneecaps.
J. Aughenbaugh: In other contexts, yes. This would be criminal behavior, instead it's being done by the government. I said, If we focus on the end, we want desegregated schools, then the end justifies the means. But I said we got to be careful with that because that's a slippery slope.
Nia Rodgers: It's a very slippery slope to say, I believe that the end justifies the means, but that's going to get hairy quick. Also, in your cooperative federalism it fails when the federal government says, We shall fund 90 percent of something. Then they say, Now we're going to fund 50 percent of that, but you're on the hook for the other 50 percent. Like that's a bait and switch. The government does that sometimes. The government will say, For the first time five years of something, we will pay X amount. It's like one of those mortgages where there is variable rate mortgages where they're like easy for a one-percent mortgage and you're like, yeah, one percent for five years and then it's 22 percent interests and all of a sudden you can't afford the house anymore. They do that sometimes, don't they the federal government?
J. Aughenbaugh: Listeners what Nia, is referring to is a well-known political science public policy concept referred to as unfunded mandates. Medicaid is in the literature, the classic example. It's always used. When the Medicaid program was created during the Johnson administration, the United States Congress said to the states, if you participate in the federal government's Medicaid program, we will give you 90 percent of the cost. We will fund 90 percent.
Nia Rodgers: That's a lot.
J. Aughenbaugh: Yes. Of course, every single state said, okay.
Nia Rodgers: Sign me up if I can only put in 10 and get nine back.
J. Aughenbaugh: I end up creating a health program.
Nia Rodgers: That makes me popular and beloved and takes care of my citizens and does all the things we want it to do, where's the piece of paper? Let me sign.
J. Aughenbaugh: But by the time we get to the late 1980s, early 1990s, the federal government share of Medicaid was 50 percent and states began to complain because now the states are in a dilemma.
Nia Rodgers: Did they remove it?
J. Aughenbaugh: Upset.
Nia Rodgers: Upset their citizens and leave some of their citizens ill and dying with no support.
J. Aughenbaugh: Or do they pony up?
Nia Rodgers: Do they take money from other things in the state?
J. Aughenbaugh: That's right.
Nia Rodgers: Because that 50 percent is going to come from somewhere. Your roads aren't going to get fixed, your schools aren't going to get fixed, your whatever is not going to get fixed because you got to come up with that money. It's a little shady. I'm just saying that's a little shady on the federal government's part.
J. Aughenbaugh: Yes.
Nia Rodgers: That's like a loan shark. It's a little shady. But you know, what's even shadier to me, is Social Security. Because Social Security feels like a Ponzi scheme. You have to have bigger generations in order for Social Security to work the way it's set up and people have stopped having babies.
J. Aughenbaugh: Yes.
Nia Rodgers: Unless we start acquiring babies from somewhere else, meaning unless we start having a lot more immigration with people who are having children and having families.
J. Aughenbaugh: Yeah. Because we know this statistically.
Nia Rodgers: Demographics are not in our favor here.
J. Aughenbaugh: Third and fourth generation Americans aren't having kids. At most they are having one or two. By the way, the current Social Security System basically needs two-and-a-half Americans to work to fund one-person on Social Security.
Nia Rodgers: Unless we're going to go to the soiling green route, which I am not advocating.
J. Aughenbaugh: No, we're not advocating that.
Nia Rodgers: Then we are going to have to see some rearrangements of that program.
J. Aughenbaugh: This all started in the 1980s when the federal government was getting criticized for using the Social Security trust fund to, on paper balance the federal government's budget. Eventually, advocates for retirees and senior citizens said, We need to go ahead and put the Social Security trust fund. That's all the money that workers pay into Social Security goes into a ''trust fund''. We need to put that in a lockbox. They can't be used even on paper to balance the federal government's budget. For our younger listeners, this is during a period in American history where the federal government was actually concerned about balancing the federal government's budget.
Nia Rodgers: I'm pretty sure they've given up on that now.
J. Aughenbaugh: Yeah. They've given up on that.
Nia Rodgers: They say they want to, but.
J. Aughenbaugh: We can talk about the ramifications of that in a different podcast.
Nia Rodgers: Oh, yeah. That's a whole different.
J. Aughenbaugh: But nevertheless, when they put the trust fund in a lockbox, then advocates were like, Let's just remove it from Health and Human Services and make it basically in independent agency. That's what Social Security is. It's an independent agency. This all finally occurred during the Clinton administration. But that's part of Social Security being the third rail of American politics because is its own agency. They don't have to worry about what goes on in HHS. On the other hand, because it's an independent agency.
Nia Rodgers: They are not being overseen by a secretary.
J. Aughenbaugh: Nobody's talking about the impending demographic nightmare that's Social Security.
N. Rodgers: It is coming. The reality is it's coming around the world. In most of first-world nations, they're are seeing a drop in birth rate.
J. Aughenbaugh: Yeah there are two more controversies I wanted to touch upon before we talk about the prominent HHS secretaries. Nia, is there one that you want to touch upon?
N. Rodgers: There is my favorite thing ever, which also is a prominent HHS secretary, Kathleen Sebelius.
J. Aughenbaugh: Yes.
N. Rodgers: She said and we shall roll out the Affordable Care Act. It will be wonderful. You will go to the website and sign up. People went I, and they went to the website in such numbers that it crashed instantaneously. It was up and down and up and down and nobody could figure out how to get their information need. Whether their information was taken or not. She kept saying, well, we didn't think this many people would want it. I'm like, are you preserve week? Of course, we knew this number of people would want it. Hear me out on this. What they should have done was hire Ticketmaster. Because Ticketmaster can handle 150,000 Bruce Springsteen fans trying to get tickets all in the same two minutes when they go on sale for their city. They can handle it. They should have been hired to do that rollout instead of, well, we don't know when the site will be back up because that gave people a lot of, well, if you can't get the website right, I don t know that I want you to be my insurer.
J. Aughenbaugh: Yes.
N. Rodgers: It did a lot to damage the ACA.
J. Aughenbaugh: Listeners what Nia is referring to is the implementation of the Affordable Care Act health insurance exchange program. Nia, I got to be honest with you. From a public administration scholar perspective, the Affordable Care Act had a two-year implementation window. The law was passed in 2010.
N. Rodgers: Yeah. They waited until like 20 min before it was going to expire.
J. Aughenbaugh: Here's the thing. The assumption about the health insurance exchange program was that the states would create their own because they wouldn't want to rely on the federal government.
N. Rodgers: They didn't.
J. Aughenbaugh: Half of the states. I think the number was like 25 or 26 of the states. Basically was this like we're not entirely sure we liked this program. We're basically going to go ahead and put it on you all shoulders. The feds were just completely shocked when a whole bunch of Americans were like, I can now get health insurance. If I don't meet certain income standards, the federal government will pay for my health insurance that will subsidize it. Right?
N. Rodgers: Right.
N. Rodgers: History will look back on that and say part of the problem with political polarization was that some of the states that didn't do it were deliberately trying to tank the program.
J. Aughenbaugh: Yes.
N. Rodgers: But their people wanted it.
J. Aughenbaugh: Yes.
N. Rodgers: The leadership in those states we're making choices that were not in accordance with what the people in those states actually wanted.
J. Aughenbaugh: Yeah.
N. Rodgers: There will be research in the future that will look back on that and say, that was pure politics. We don't like Obama, we don't like his Obamacare and we are going to drag our feet even if it hurts our state's population. I really believe that.
J. Aughenbaugh: In that situation from a public policy implementation perspective, if you know you got that resistance, then you have to be even better at implementation.
N. Rodgers: What's amazing is she been a governor, like she knew stuff. She was one.
J. Aughenbaugh: She was a former governor of Kansas. She had to know this. Kansas is one of the most conservative states in the country, right?
N. Rodgers: Right. She had to know there was going to be pushed back and there was going to be drama. But she didn't read the room as well as perhaps.
J. Aughenbaugh: Again, as you pointed out, the federal government is good at some stuff, but not necessarily at other stuff. When you're rolling out a program that was fundamentally reforming one of the largest industries in the United States,
N. Rodgers: It needed to be really clean and it just wasn't.
J. Aughenbaugh: It wasn't. You have to have all your ducks in a row. You have to dot all the Is, cross all the Ts. They didn't.
N. Rodgers: Yeah. They did not. I'm just saying if they had hired Ticketmaster, it would have been better.
J. Aughenbaugh: Then, of course, the most recent controversy.
N. Rodgers: Not that I'm an advocate of Ticketmaster by the world. Criminal fees they charge, but we won't even get into that usury.
J. Aughenbaugh: Is somebody who tried to get Bruce Springsteen tinted? Was shot dead.
N. Rodgers: Because now they have desire pricing where if it's a super popular location or concert, the ticket prices automatically go up.
J. Aughenbaugh: Yes.
N. Rodgers: Anyway, you want to talk about the other one which is also good. Well, not good, but I mean, it's quite controversial.
J. Aughenbaugh: Well, I mean, we touched upon this in a previous podcast episode with our colleague Dr. Judy Twig. But it's the CDC/Health and Human Services response to COVID-19. Again, federalism played a huge role here because the CDC was giving Americans advice about how to respond. Some of that advice turned out to be unnecessary. Shall we say? Did I say that diplomatically?
N. Rodgers: You did. There's no real need to wash your groceries. Well, I mean your vegetables.
J. Aughenbaugh: But like many Americans, I was coming home from the grocery store.
N. Rodgers: Wiping things down. Taking off your gloves and throwing them away.
J. Aughenbaugh: Now we found out COVID doesn't spread that way. Fine. But the CDC's authority is limited.
N. Rodgers: He pushed right up to the edge of that.
J. Aughenbaugh: Yes, they did.
N. Rodgers: At that authority to make everybody wear a mask which by the way, I don't argue with because I just flew on a plane and I wore a mask and I didn't get a cold and I'm like, masks work.
J. Aughenbaugh: But again, this is one of those situations to where you have a constitutional cultural norm in the United States that public health historically is the domain of states. The CDC has limited authority because of federalism, but it also has limited authority in regard to what Congress has given it in law. In both the Trump and Biden administration let's be very clear. This wasn't a Democrat versus Republican thing.
N. Rodgers: Oh my gosh. Who was it when Reagan was shot? He's Haig. General who Haig said, don't worry, I'm in charge here. Unlike the rest of the government, you know that's not how that works. We have the House, the Speaker of the House. We have the Pro Tem with Vice President, Speaker of the House of Pro Tem. Like we have an order to things. Now Haig was like, no, I got this. I'm in charge. It's fine.
J. Aughenbaugh: He's the Secretary of State. We're like, what's the Secretary of State doing responding to the President?
N. Rodgers: It's panic. It's what happens when there's panic and there's that moment of somebody needs to step up and take control.
J. Aughenbaugh: You have President Trump who was in press conferences saying, yeah the CDC is going to take care of it. Of course, a whole bunch of us are like, really?
N. Rodgers: Do they have the authority to do that?
J. Aughenbaugh: Trump gets roasted for two-and-a-half years, Biden comes into the office and the next thing you know his CDC is like, we have an eviction moratorium.
N. Rodgers: Wait, do you have the power to do that?
J. Aughenbaugh: We have the power to do that. Well, you know, hey, Trump did it. We're like so now we're using rob. That's what I used to say when I was a kid.
N. Rodgers: My friend did it. My sister did.
J. Aughenbaugh: If all gets away with this why can't I? That never worked then it doesn't work now.
N. Rodgers: Oh my goodness. But we've had some great secretaries that we've had some pretty fabulous. Then we've had some secretaries where I'm like, oh, I'm slightly embarrassed for you. I mentioned Kathleen Sebelius, not because I think she was a bad secretary, but because that rollout was under her and the buck stops with her as Janet Reno said about Waco, the buck stops with me. She wasn't in Texas when that happened. But she was ultimately responsible for the outcome.
J. Aughenbaugh: Yeah and the three general and guess what? He used that botch the Waco raid.
J. Aughenbaugh: Fall under her.
N. Rodgers: Yeah. Fall under her purview.
N. Rodgers: Kathleen Sebelius gets that she will be forever remembered as, hey, didn't you screw up the ACA implementation?
J. Aughenbaugh: Yes.
N. Rodgers: But you know I did all these other things in my career and did really well.
J. Aughenbaugh: Yes. The first one who was appointed by LBJ. Again, this is reflecting my desire for bipartisanship in being a moderate. But John Gardner was LBJ's Health, Education, and Welfare Secretary.
J. Aughenbaugh: He was the only republican in the Johnson administration. But he had a second career. He created common cause, which is a public interest group.
N. Rodgers: He had a very strong moral street because didn't he resign?
J. Aughenbaugh: Yeah, he resigned to oppose the Johnson administration's escalation of our involvement in Vietnam. Another one with a strong, if you will, moral backbone, Elliot Richardson.
N. Rodgers: Which you and Newman waxed poetic about.
J. Aughenbaugh: Yes, okay. Again different era. Because Elliot Richardson, in addition to being secretary of Health Education and Welfare, became the Attorney General of the United States and that's when Nixon said, "You must fire the special prosecutor investigator."
N. Rodgers: That's right, and he resigned.
J. Aughenbaugh: Richardson said, "I refuse," and Nixon said, "I expect your resignation," and now here Richardson's like, "You got it, Mr. President."
N. Rodgers: Here it is on a napkin, bye.
J. Aughenbaugh: But you had others. For somebody from the state of Pennsylvania. Richard Schleicher. He was a former Pennsylvania senator. Another moderate republican, Donna Shalala. She was President Clinton's secretary of health and human services. She rather controversially was one of the most public, ardent supporters of President Clinton during the Paula Jones, Monica Lewinsky scandal.
N. Rodgers: I remember that. I remember her supportive him, her very public supportive and she left, I don't remember what she left to do.
J. Aughenbaugh: She became the president of the University of Miami. Yes.
N. Rodgers: You know what? That's a thing, isn't it? Leaving to become the president in something as we're recording this, Ben Sasse, is leaving to become the president of a university, isn't he?
J. Aughenbaugh: Yes. Ben Sasse, as we are recording, is still one of the US senators from the state of Nebraska. But he's already announced his intention that's if the Board of Trustees in the State of Florida approve, he's going to become the president of the University of Florida. Yeah.
N. Rodgers: Going on to be university presidents, I'm just saying that's an interesting career route to that position. That also tells folks that we're recording these episodes a few weeks early. We're doing that in part because we're also doing some in the news things on the side that you'll see as they come out.
J. Aughenbaugh: You know who else? Mitch Daniels, who was a budget official for Bush 43, became the governor of Indiana and is currently the president of Purdue University. I think this is his last year. I think he's already announced he is retiring from public service at the end of this year. Anyway, I digress.
N. Rodgers: Being a president of a university is tough job. It's hurting cats in a whole different way.
J. Aughenbaugh: Increasingly, universities are not just about education, somewhat would argue they're not only about education.
N. Rodgers: Right, some would argue that at that point you're a CEO. It's a corporation.
J. Aughenbaugh: Yeah.
N. Rodgers: Can we mention one more?
J. Aughenbaugh: Yes.
N. Rodgers: Which is Tommy Thompson?
J. Aughenbaugh: Yes.
N. Rodgers: First of all, I love that. I love that somebody named their child Tommy Thompson. I'm Tom. He worked for Bush 43?
J. Aughenbaugh: Yes, he did. Yeah. Former republican governor of Wisconsin. It was his state's welfare reform program that became the model of welfare reform that was enacted during the Clinton administration.
N. Rodgers: Okay.
J. Aughenbaugh: Yeah.
N. Rodgers: He tried it out on the state and then went to the federal level. That's actually not a terrible idea.
J. Aughenbaugh: Well, that's one of the justifications, by the way, for federalism. States, according to the infamous quote from former Supreme Court Justice Louis Brandeis, states are the laboratories of democracy.
N. Rodgers: I was about to say, isn't there something about they are the laboratory of something? That's what it is.
J. Aughenbaugh: Yeah.
N. Rodgers: Where we are now, HHS, I would say that it is a relatively powerful department in that you see something well, as the CDC shows. It can affect every single individual in the nation and generate lots and lots of lawsuits and lots of controversy.
J. Aughenbaugh: It is one of the rare federal government departments that can affect Americans from birth to death.
N. Rodgers: That's true. Cradle to grave.
J. Aughenbaugh: Yeah, cradle to grave.
N. Rodgers: It gets you the whole way through.
J. Aughenbaugh: You can't say that about a lot of other Cabinet departments, but that one you can say.
N. Rodgers: I doubt this is one that you could easily get rid of. The entrenchment here. You know how sometimes some politicians say, "When I'm president, I'm going to get rid of the following departments." I don't know if I've ever heard anybody list HHS, but if they have, boy that would be a thing that would not go over well with the American public.
J. Aughenbaugh: Well, think about it.
N. Rodgers: As much as we like to argue about the CDC or the Obamacare or whatever, we also as a fundamental part of the fabric of the nation now, think of these things as fundamental rights.
J. Aughenbaugh: Think about this, Nia. The number of parents who would be just up in arms if you got rid of head-start. I can easily feed my daughter breakfast every morning, but the fact that her school has a head-start program, I basically know that if I have a difficult time waking her up to get her to the bus, that when she gets to school, she will eat something.
N. Rodgers: Medicaid and Medicare what are we going to say to our old folks and our poor folks? No medicine for you?
J. Aughenbaugh: Yeah.
N. Rodgers: We're not going to do that as a nation, not now that we've had it for a while. It's one of those things that once it becomes entrenched.
J. Aughenbaugh: That's the institutionalism. That's the public policy, if you will, perspective known as institutionalism. We created in the institution for a particular problem. But once it gets created, then it shapes the behavior and expectations of multiple generations of America, right?
N. Rodgers: Right. I know there are people who are like, away with the CDC, but they don't really mean that.
J. Aughenbaugh: No.
N. Rodgers: Because there's a whole bunch of things that they want the CDC to do. They just don't want to overreach.
J. Aughenbaugh: Nia, you've heard me say this both on recording and when we've discussed outside of recordings. I've been somewhat critical of how the CDC responded to COVID-19. On the other hand, the next time there is an Ebola-like plague.
N. Rodgers: I want the CDC on it.
J. Aughenbaugh: Oh my goodness. Do I ever? Right?
N. Rodgers: Yeah. Here, let me make room for you at the airport. I want you to fly in and fix it. Oh my, well, I'm not happy about OneNote. We're going to go and we'll be back next week to talk about the next department.
J. Aughenbaugh: All right. Sounds good, Nia. Thank you.
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