Gov. Gretchen Whitmer’s promotion of Elizabeth Hertel as director of the Michigan Department of Health and Human Services offers an opportunity to break up the state’s largest agency and reshape how public health services are delivered after the coronavirus pandemic.
MDHHS is a behemoth, the result of former Gov. Rick Snyder merging the community health and human services departments like they were two homogeneous corporations in need of a marriage.
With 14,244 employees, a $25 billion operating budget and a customer base that’s easily one-third of the state’s 10 million residents, MDHHS on its own could be the state’s 15th-largest employer, between the U.S. Postal Service (18,000 employees) and Michigan State University (11,850), according to Crain’s company data.
The director of this state department that oversees the payment of billions in tax dollars to private insurance companies that manage the Medicaid insurance program for the poor is paid $182,070 a year to run it.
For some perspective, that’s 1.5 percent of the $12.1 million that not-for-profit Blue Cross Blue Shield of Michigan paid CEO Daniel Loepp in 2019 to lead one of the insurers that manages Medicaid program for the state.
Outgoing Detroit Zoo CEO Ron Kagan and four of the zoo’s top executives are paid more than the MDHHS director to manage a zoo with a $45 million annual budget.
The median base pay of CEOs at 59 Southeast Michigan nonprofit organizations in Crain’s annual survey last year was $390,088 — more than twice what Hertel will be paid this year.
The MDHHS director’s responsibilities are seemingly endless: You oversee child welfare and adoption, tracking communicable diseases, programs to help the homeless, managing food and cash assistance for the poor and so much more.
And as former MDHHS Director Nick Lyon and chief medical executive Dr. Eden Wells have found out in Flint’s water crisis, if you don’t pay close enough attention to one fire that you think the scientists in the bureaucracy have handled, you could get prosecuted for involuntary manslaughter.
Who would want this job for $182,000?
Whitmer is aware of the limitations in recruiting and retaining executive talent to state posts that pay far less than C-suite gigs in both the private and nonprofit sectors.
During her 2018 transition, Whitmer studied breaking up MDHHS and told Crain’s at the time that a split would be “almost as hard as keeping it together and making it work … if not harder in some respects.”
But a lot has changed since December 2018.
Whitmer is in the throes of a once-in-a-lifetime global pandemic where the MDHHS director has had to focus almost solely on managing a health crisis that’s claimed more than 14,500 lives in 10 months.
The governor said last week that her administration is again studying a breakup.
“We’re taking a look at it,” Whitmer told Capitol reporters. “To be very honest, that’s always been a conversation that we’ve been having. It’s an enormous department. It touches people’s lives in profound ways.”
Undoing Snyder’s 2015 merger of the community health and human services departments would “not be easily accomplished,” Whitmer said.
“Like any decision about the organization of state government, there are benefits and detriments to separating some things out,” she said. “But there is an ongoing conversation.”
Whitmer’s appointment of Hertel to lead MDHHS after the abrupt and still unexplained resignation of Robert Gordon would seem like a good time to reorganize this government agency — and reprioritize how it manages threats to public health.
Throughout the pandemic, we’ve seen firsthand how unprepared public health systems in this country were for a highly contagious airborne virus to sneak into our homes, stores, businesses and schools and wreak havoc on society.
The infrastructure for expedited testing of people for the virus was almost nonexistent a year ago.
Few in state government even knew how to quickly acquire personal protective equipment.
And the state’s disease-tracking system, designed in the early 2000s, isn’t equipped to track COVID-19 outbreaks by settings, forcing public health officials to use a consumer-grade version of Survey Monkey to gather information that is critical in knowing where the virus is spread.
Michigan has a highly decentralized community public health system that doesn’t always work well with hospital systems or other government agencies.
This was on full display in the Flint water crisis when MDHHS bureaucrats got into a pissing match with Genesee County’s health department over how to investigate a Legionnaires’ outbreak in 2014-2015 that’s blamed in at least a dozen deaths. The finger-pointing resulted in the public and local doctors being left in the dark about a threat to public health.
Lyon and Wells could go to prison for the rest of their lives if they’re convicted of involuntary manslaughter in nine of those deaths.
Splitting the department will inevitably cost money and require the Democratic governor to make a case to the Republican-controlled Legislature that new investments in a standalone Department of Public Health are needed to prevent another deadly COVID-19 pandemic from ravaging life and livelihoods.
Lawmakers and the governor can quibble over the money.
But it’s hard to argue that the Michigan Department of Health and Human Services has been set up for success.
