This section is from the "The Subvention In The State Finances Of Pennsylvania" book, by Frederic B. Garver.
On the whole, the admissions of the secretary amounted to a confession of inefficiency and mal-administration in the management of the local asylums. He was unwilling, however, to recommend the abolition of the system, preferring to advocate a reform of the existing arrangements. Moreover, the Chairman of the Committee on Lunacy, Mr. Isaac Johnson, in his report to the Board of Public Charities, in 1915, strongly defends this county care system. *91 He asserts that the condition of the insane in the local almshouses has been steadily improved during the preceding twenty years, and that the distribution of the chronic insane in small asylums is preferable to assembling them in large numbers in state institutions.
If the state should undertake to provide hospital facilities for all the indigent insane, the present appropriations would undoubtedly prove insufficient. This would necessitate either an increase of state revenue, or an increase of the proportion of the cost now borne by the counties, or a reduction of state expenditure for other objects. When the first state asylum was established, the counties committing indigent insane to it were charged with the entire cost of maintaining them, the state providing only the material plant. *92 Later, in 1893, the removal of all insane to state hospitals was made mandatory and the state agreed to pay one-half of the cost of their maintenance. *93 At the present time, the state pays $2.00 a week for the support of insane in county hospitals in the county-care system. It also pays not more than $2.25 per week for the maintenance of patients in state hospitals. The remainder of the cost in the first case must be borne by the county. In the latter, a fixed contribution per patient per week is required of each county. *94
91 Idem, pp. 271-275.
92 Haviland, The Treatment and Care of the Insane in Pennsylvania, p. 9. 93 Idem, p. 11.
It seems unlikely that the counties will be asked to contribute toward the cost of building state hospitals, and it is clear that if additional hospitals are to be provided the state must pay for them. The tendency in all branches of education, in road building, and in charitable relief is toward centralization and concentration. Practically, the state could not require the counties to pay a greater proportion of the cost of maintaining the insane in state asylums.
But if the state shall be compelled to expand this service, it will need additional revenue. Were other branches of state expenditure stationary, this would not be a difficult matter. But this is not the case. The first element in the increasing cost of government in Pennsylvania consists of those services included under the head of general government. In 1903, the cost of these services was $1,663,027 and by 1913 it had increased to $2,907,148, *95 or an increase of 74.8 per cent in ten years.
The cost of protection to persons and property increased during the same decade from $1,384,558 to $1,758,987, *96 or a gain of 27.0 per cent. In 1903, the state paid out $44,608 for highways and in 1913 the amount expended in building and maintenance of roads was $1,516,361. *97 The growth of expenditures for educational purposes as has already been shown has also been very rapid. *98
94 Haviland. The Treatment and Care of the Insane in Pennsylvania, pp. 11-12.
95 Bureau of the Census, Wealth, Debt and Taxation (1913), II, pp. 40, 42.
96 Ibid. 97 Ibid.
98 See supra Ch. VII.
Given the condition of increasing cost of services now borne by the state, only two methods are open for financing the needed hospitals to care for the insane and other defective classes: either the state must develop new sources of revenue or it must economize and restrict expenditures for services now performed. Probably it could do both. But there are no data now at hand to show where these economies could most profitably be effected. With a total expenditure amounting to over $35,000,000 net (in 1916), the state needs a scientific budget. It also needs a thoroughgoing investigation of state and local revenue systems by non-partisan experts to determine whether the corporations which now pay the greater part of the state taxes are contributing more or less than should in justice be demanded of them.