Opinion

Pay now or pay more later often policy choice

TROSA President and CEO Kevin McDonald, right, congratulates Rickie Russell during a graduation ceremony in Durham, N.C. on Sunday, August 23, 2015. Durham-based TROSA wants to build a second campus in the Triad region, either in Greensboro or Winston-Salem.
TROSA President and CEO Kevin McDonald, right, congratulates Rickie Russell during a graduation ceremony in Durham, N.C. on Sunday, August 23, 2015. Durham-based TROSA wants to build a second campus in the Triad region, either in Greensboro or Winston-Salem. newsobserver.com file photo

An observation by New York Times columnist Nicholas Kristof caught my eye last week, especially in the context of several stories in the news.

“America’s greatest failure in the 21st century may be that far too many children grow up in a twilight zone of poverty, chaos, violence, drugs and failing schools,” Kristof wrote. “We can’t afford to help them, we say, and then we spend billions of dollars building prisons to house them.”

It is a theme that runs through many public-policy discussions. Too often, we focus on the cost of programs to help children, victims, recovering substance-abuse users, the sick, among others, while ignoring what might be called the opportunity cost of not tackling problems before they fester into serious malignancies that land people in prison, on the streets or hospitalized for conditions that could have been averted or minimized by less costly early care.

That point was driven home by an RTI International study my colleague Zachery Eanes reported on last week.

“The services provided by Durham-based Triangle Residential Options for Substance Abusers (TROSA) save North Carolina millions of dollars annually,” Eanes wrote in summarizing the RTI findings. “The independent study found the treatment center saves the state $7.5 million every year, mainly by preventing arrest, incarceration and emergency hospital visits.”

It is that sort of data that helps nonprofits like TROSA — founded in 1994 by the indefatigable Kevin McDonald — make the case to government funders, foundations and private donors that the work is about more than simply caring about fellow human beings in need, as important as that is. It saves society money in the long run, an argument that ought to appeal to hard-nosed business types and conservatives who may be less swayed by the help-they-neighbor approach.

“It certainly makes (our) argument easier to make whether it is presenting to the state, an individual or any philanthropic organization,” said Keith Artin, TROSA’s chief operating officer.

Joshua Scruggs, 35, a TROSA client who says he was a methamphetamine user in and out of prison several times before he entered TROSA’s two-year residential program six years ago, bears witness to what the RTI numbers show.

“I am 100 percent sure I would’ve made it back into jail or worse,” Scruggs said. “You don’t think about it during addiction, but you are costing the taxpayer money all along the way.”

As striking as the $7.5 million savings figure is, RTI researchers say that was based on conservative computation of the avoided costs. “TROSA’s savings to the state are likely even larger if you factor in the vocational training and education programs it provides,” wrote Alexander Cowell, a senior research economist at RTI.

The potential savings to society by appropriate and early intervention figure in arguments for expanding pre-kindergarten education programs, a long-standing goal of early-childhood advocates and focus of a task force’s study commissioned by the city and county governments and the Durham Public Schools and released last month.

The inexorable push by Congress and President Donald Trump to eviscerate the Affordable Care Act, probably reducing the number of insured Americans by more than 20 million, may save taxpayer money up front. But it will once again mean vulnerable Americans — young, old, economically struggling — will cost us more in expensive emergency department visits, chronic or acute illnesses that could have been avoided by earlier care, lost income and expensive rehab costs.

Penny wise and pound foolish is a weary cliche, but one that too often comes to mind when public policy reflects fiscal short-sightedness.

Bob Ashley is editor of The Herald-Sun. You can reach him at 919-419-6678 or bashley@heraldsun.com.

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