After November’s election results, I’m left wondering…was it a referendum on the President? Where were all those young Obama supporters? Is the GOP dead of its own internal bickering? That independents would within one year swing from Obama enthusiasts to backing decent-to-weak Republicans in Virginia and New Jersey is “simply astonishing,” writes The Wall Street Journal opinion editor.

I don't think it's so astonishing. But, it means accepting the fact that technology has made both political parties—as they currently operate—irrelevant. The world of Internet information; web-based political advocacy groups; and flash mobs (e.g. ‘tea party’ folks) has changed the political landscape. Political parties no longer have coherent platforms that mean anything to anyone and they don't have the ‘member control’ that allows them to mobilize voters. In the future, the winning candidate (and the winning party) will be one who can engage the independent voter around specific issues by using technology to build candidate-specific coalitions of specific voter and interest groups.

For health care reform, both parties are at risk. For the Democratic Party, they're going to need to realize that Americans are skeptical about the operation of the current 'public options' (Medicare, Medicaid, IHS, TRICARE, VA) and don't want to abandon their perceived personal ability to pick a health plan or a professional. Republicans are going to have to go beyond the 'party of no' and "Kill the Bill" rhetoric. Americans know they’re in danger of losing health insurance when they lose their jobs; that many health insurance company policies are nightmares; and that most of us are one serious disease away from bankruptcy. The party that ignores the 'middle view' on health care reform will pay the political consequences for whatever happens with health care.

The report in USA Today was brief, but its implications leapt off the page for me:

“In the eight states that report monthly tax figures, collections from July through September declined an average of 8.3 percent from a year earlier. Even in places where there's been an income tax increase, such as New York, collections still declined. This comes after there was a 15 percent nationwide drop in tax collections during the first six months of the year.”

With health care in general (and behavioral health and social services in particular) dependent on state financing, I think the ‘end of the recession’ is nowhere in sight – despite the pronouncements of economists. Look for reductions in Medicaid (reduced eligibility, reduced service coverage, reduced provider fees, and more risk-based contracts) and cuts in state-funded services (mental health, addictions, child welfare, juvenile justice, prison health, senior support services, etc.) as the reality of tax collections cause state governments to open up their budgets once again.

If you’re a manager of an organization providing health services or social services – or a county commissioner – the pending tax shortfalls will have the biggest impact on your work. Now would be the time to develop a contingency plan.

For more on planning and managing in these harsh economic times, check out:

• On the Money - The Key Financial Challenges Facing Nonprofits Today - and How Grantmakers Can Help
• The Wolf is at the Door: The Global Economic Crisis and the Public Sector
• Surviving & Thriving in a Recession: A Management Blueprint for Health & Human Services
• Changes in Health Care Financing & Organization: Impact of the Economy on Health Care

Advocates and provider organization management teams are all tracking state budget problems and what they mean for mental health. A few of my colleagues are breathing a sigh of relief because their state budgets left them 'relatively' unscathed. But, for behavioral health and social services, I think the worst budget cuts are yet to come. In 2010, we will have to deal with the effect of the planned state budgets—and probably some mid-year revisions. But, in many jurisdictions, provider organizations will see county and city budgets for these services unravel. On Saturday, ABC news in El Paso, Texas reported that of the El Paso City Council members, four voted to cut ties with the El Paso Mental Health and Mental Retardation agency. Their rationale is that, by law, those services are the responsibility of the county—not the city. ABC-7 reporter Daniel Marin wrote:

"El Paso City Representative Beto O'Rourke says, by law, MHMR is the responsibility of the county. So he along with special city council committee
members… voted to cut ties with the agency…O'Rourke says MHMR's highly publicized funding issues are the result of the old cliché: too many chefs in the mental health care kitchen…"

"MHMR spokesman Rene Hurtado says while every little bit of funding helps, this is all about more than losing the city's $100,000 yearly contribution. "The mental health care system is very complex," said Hurtado. "The more people we have at the table, the better it is for everyone."

"El Paso County Commissioner Anna Perez says, in her opinion, the city has a direct role in helping the city's mentally ill; adding there's too much at stake for city officials to hide behind a law. "[The law] doesn't mean they don't have a place at the table," she said.

The unfortunate reality? Our current systems for mental health treatment, for addiction treatment, for child welfare, and for other social services are strung together with a hodgepodge of federal, state, county, local, grant, donation, and payer dollars. From my perspective, parity and universal coverage can't come too soon. I'll look forward to a time when Americans with behavioral disorders and disabilities are not begging for safety net funding and charitable donations.