Commentary: History speaks clearly to SC health agency reforms

May 19, 2024

Oran P. Smith, Ph.D

Senior Fellow

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: