This column by Senior Fellow Dr. Oran Smith originally appeared in The Post and Courier May 19, 2024.
Looking back over South Carolina’s civic life, most historians would agree that Carroll Campbell has been among our state’s most effective governors. It was Campbell, a Republican with a General Assembly that was 61% Democratic, who shepherded through a comprehensive restructuring of state government in 1993.
It is hard to imagine today, but before the former Greenville congressman’s reform plan was enacted, South Carolina’s governor was hands-down America’s weakest. State agencies were run by boards and commissions, some of which included legislators. There was no governor’s Cabinet, and executive authority was diffused so widely and thinly that citizens often wondered who was in charge.
There were a number of reasons for Campbell’s success, some of which seem almost paradoxical. He was clearly very conservative, but he believed passionately in reform. He was a fan of the “too conservative” Ronald Reagan, but he also decried “horse and buggy government.” He favored shrinking the size of government and knew well the balance that the framers sought to build into public policy: Power should be concentrated just enough to ensure effective governance, but not enough to open the door to tyranny.
Campbell’s conservative but reformist legacy and his understanding of the appropriate balancing of power speaks into the final stage of a current debate; following the division of DHEC into separate environmental and health agencies, the General Assembly is taking the next step by streamlining the health functions of six state agencies into the Executive Office of Health and Policy.
Unfortunately, even after the Senate passed S.915 by a vote of 44-1 and the House by a margin of 98-15, some concerns have prevented the enactment of the legislation to establish this new department from pieces of existing ones. But those concerns aren’t based in reality:
- There is no South Carolina version of Anthony Fauci here. The governor can remove the executive secretary of Health and Policy at any time, and the General Assembly can still direct the governor to remove a Cabinet officer with a two-thirds vote in each chamber.
- Some powers will move, but no new powers will be created. In at least one case, emergency powers on the books since 1908 were modified during the S.915 amendment process to clarify that only the governor can exercise them.
- The governor’s choice for secretary will not be micromanaged with a long list of bureaucrat-friendly required qualifications in the enacting statute.
- Employees of the consolidating agencies and offices will move to positions in the new component departments, but natural redundancies will create the opportunity for savings. The General Assembly can tighten the purse strings as well.
- One of the remaining post-Campbell unelected and unaccountable governing boards, the DHEC board, is dissolving, and the health policy buck will finally stop with the governor.
- There has been no unseemly rush. The massive restructuring legislation under Campbell was accomplished in about five months. This much-less-ambitious health restructuring will have taken about the same amount of time from beginning to end. Factoring in time spent on the legislation splitting the Department of Health and Environmental Control, the Office of Health and Policy timeline has been even longer than the 1993 restructuring.
- Thanks to a subsequent reform, which established legislative oversight committees, the new agency will appear regularly before the Senate and House to answer for its actions. Citizens also have the ability to lodge a complaint about the agency with the oversight committees.
The establishment of the Executive Office of Health and Policy represents a significant opportunity — not only to save taxpayer dollars by eliminating duplication that went unaddressed in 1993 and 2014, but to serve our citizens more effectively, particularly those with complex health needs who have been underserved by the confusion that comes from existing unaligned agencies.
But the new agency will not have absolute power. The supreme authority of the governor, oversight and confirmation procedures already in place and additional safeguards built into the legislation are designed to protect the rights of citizens. There are additional political, legal and administrative remedies outside of these as well.
The Executive Office of Health and Policy is a reform whose time has come, a reform that I feel sure the Ronald Reagan Republican Carroll Campbell would have warmly embraced.
Oran Smith, senior fellow at Palmetto Promise Institute, served in the Campbell administration.
