Friday, May 18, 2007

The Health Commissar

Dr. Thomas R. Frieden, New York City’s Health Commissioner, is not tzu-frieden (Yiddish for “satisfied”) with performing the routine important responsibilities of his agency, such things as rats in restaurants, tens of thousands of children who get no or inadequate health care and a multitude of problems experienced by patients in hospitals. His ambition and ideology take him to more arcane pastures where political correctness yields media attention. For all of his obvious talent, he is as much an exhibitionist as he is the guardian of public health.

One recent crusade was aimed at verbal transgendering, a process that would allow persons to alter their gender not through surgery but by simply declaring that they are now of the other sex. When that strange idea was quickly quashed, the good doctor remained transfixed on the concept of “trans” and so he was off to the races battling against transfats in restaurants. It may be good to reduce or eliminate entirely reliance on this ingredient, although the intrepid health police who constantly bemoan a succession of real or imagined health crises might ponder the powerful implication of statistics showing an astounding increase in life expectancy. The rest of us may ponder whether Big Brotherism is good for our political health.

Dr. Frieden’s latest target is child care. The Health Department has drafted a ton of regulations that fill forty plus pages. The implementation of many of them would have a devastating impact on non-profit child care, particularly services sponsored by religious groups. I believe that this is the intention.

There are rules for everything, down to the most minute detail. At least twelve cover diaper changing. One regulation mandates that “children shall receive no more than six ounces of 100% juice per day.” Another says that cribs cannot be stacked. Signs must be posted about everything and all kinds of permits are required. Training galore is mandated and there are impossible rules relating to staffing and space. In Dr. Frieden’s child-care dystopia, bureaucracy runs amok.

The implementation cost for government and child care providers would be astronomical and it is a good bet that many facilities could not continue to operate. What is at issue is not whether such facilities must adhere to health and safety standards, nor is there any question that steps need to be taken to ensure that child predators are not employed and that staff is screened to determine whether any have a criminal record. The issue is the large number of unneeded requirements that would cause havoc to the child care system.

As an aside, one rule is dangerous. It requires that “parents shall have unrestricted access to their children at all times.” Putting aside whether this is wise or unreasonable, there is the serious issue arising from the expanding frequency of divorce and attendant child custody battles. In all educational settings, there is a daily real-life problem of guarding against intrusion by unauthorized parents who may seek to remove the child.

Whenever government seeks to institute or expand a regulatory scheme, there should be a three-prong test to assess its reasonableness. The first is a showing based on experience and data that what is being proposed is needed, that there is an existing deficiency that warrants correction. Secondly, there is an obligation to consider the cost, primarily financial but other costs as well, of implementing the scheme. A cost-benefit analysis might indicate that the expense of doing what is suggested outweighs any possible benefits. Thirdly, care must be taken to ensure that implementation does not result in collateral damage.

The draft regulations fail on all three counts. There are no data or research or experience providing a basis for many of the proposed regulations. Secondly, the cost would be in the stratosphere, far beyond the reach of nonprofit providers that get little or no public funding. Thirdly, what would emerge is a bureaucratic nightmare, with children and poorer families being the principal victims because many child care facilities would be forced to closed.

The draft proposals appear to target programs sponsored by religious groups. They rely substantially on staff that may not have the training and licenses that health bureaucrats favor. If there is a deficit, it is amply compensated for by an abundance of devotion. Religious groups have strongly protested, arguing in part that the proposals intrude on their right to operate in accordance with their religious precepts and also that they cannot comply with many of the rules. A meeting with Dr. Frieden resulted in a “Dear Colleagues” letter in which the Commissioner agreed that his agency “would not apply curriculum-related requirements, including teacher/staff qualifications, to religious schools.” While the agency will continue to monitor health and safety conditions, as it should, Dr. Frieden acknowledged that there are issues “that we need to discuss further.”

This is progress, but not even close to enough. Child care not sponsored by a religious group would be subject to requirements that many programs cannot fulfill. Even with the concessions made to religious groups, they would not be able to comply with dozens of regulations that dramatically increase their costs. I wonder whether the Health Department piled on in the initial draft in the expectation that if it had to pull back somewhat because of protests, what would remain is a vastly expanded regulatory scheme.

While primary responsibility for the imperialistic view of his office’s mandate rests with Dr. Frieden, Mayor Bloomberg cannot be absolved. For all of the good he has done and achieved in his tenure, there is a coldness and arrogance in his approach, a deafness toward those who are most directly affected by some of the actions that his administration takes.