The compounding deficit of unmet needs

The US generally treats infrastructure and government services, especially social infrastructure, as a liability, which limits what government budgets recognize as the full cost of providing it. Our budgeting and accountability systems measure the money spent providing services, but not the costs created when needs go unmet. 

Federal, state, and local governments divide responsibilities among separate budgets and agencies. An increase in disability services funding appears as a cost for one department. The costs avoided in emergency rooms, hospitals, criminal justice, schools, families and lost employment may occur elsewhere, or years later. The budget sees the expenditure, but not the cost avoided. 

Much infrastructure, from clinical supports to road maintenance, is delivered by private companies or non-profit organizations. Governments establish eligibility rules, specify what services are authorized, require documentation, conduct site visits and measure indicators. These accountability mechanisms are designed to verify that funded services are delivered as intended. They don’t account for what people needed but didn’t receive. 

Accountability isn’t exactly quality control, as we might expect, it’s cost checking the existing systems. 

A government can say, here’s what we’ll provide, who qualifies, what it will cost and how we will hold the providers accountable. But there’s usually no account for the people who qualify for something the system doesn’t provide, the infrastructure that is allowed to deteriorate or the future costs created by those decisions. 

This makes an unmet need look like a zero cost option. 

A student who doesn’t receive a needed intervention, a person who doesn’t receive disability support, or a road that doesn’t receive maintenance can all disappear from the current budget. The consequences may emerge somewhere else later, and at an increased cost. Deferred maintenance behaves similarly to high interest debt. So can deferred social infrastructure. 

When government tells us that the cost of services is too high, the budget shows what the government has chosen to spend. It doesn’t show the cost to meet the need, or the cost of unmet needs. A projected deficit or a large budget line item may demonstrate financial pressures, but doesn’t establish the full cost of the problem. Yet, these are the numbers used in decisions that impact us. 

Of course there should be accountability systems for government expenditures, but there should also be equivalent systems for measuring value.  

Government budgets are presented as objective truths. But as long as our accounting systems treat investments in people and infrastructure as costs, without accounting for the capacity, value and savings they create, these budgets will be incomplete. Remember this, and trust what you see in your schools, neighborhoods and everyday interactions. The most expensive thing we can do is nothing at all.