I’ve written before about my mother’s back pain. Despite many different attempts by a pain specialist, she’s experienced no relief. Despite more daily meds, her quality of life has taken a turn for the worse. Last month she made a pilgrimage to a respected neurosurgeon at Loyola University Medical Center in Chicago. Pointing to her MRI, he sadly told her that her problem was very serious and that major spinal fusion surgery might help—but that the procedure is ill advised for an 85 year old patient.

Depressed about the pain and the prospect of being confined to a wheelchair, she’s willing to try anything. A presentation at her retirement community offered bioelectric therapy—“in the comfort of your own home at no cost to you—we will bill Medicare and your insurance. Any copayments are our responsibility.” She signed up and was scheduled for an appointment within a week. The good doctor and his friendly team rolled up to her townhouse, set up a table in her living room and proceeded to inject her back with—well, she’s not sure, he’s the doc—and ran an electric device over her spine. They scheduled her for twice-weekly treatments. A few days later the same group sent another doctor with a portable ultrasound and conducted a complete physical exam (he declared her healthy).

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New York’s Attorney General, Andrew Cuomo, has made government restructuring a centerpiece of his campaign for Governor—a necessary and welcome platform! As his Plan for Action notes, we’d never have designed the current system. Rationalizing local government can improve the quality of public services and save tax payers money.

Along the way, populist sentiment at the local level has fueled grass roots efforts to “reduce layers of government”.  Journalists and politicians alike have cited New York State’s numerous special districts as the source of our problem.  I read in a newspaper article recently:

“There are 62 counties, 62 cities, 553 villages, 698 school districts and 932 towns. And then the whopper: 6,927 special districts that include local lighting, sewer, fire, water and drainage districts.”

The article goes on to say that these 10,092 districts (outside NYC) “can tax people”.  From my vantage point, however, the problem is largely not with the special districts, even though the number of special districts is the most eye-catching.  In reality, not all of these 10,092 districts have the independent power to tax people.  Municipalities and school districts have the power to levy taxes.  Of the 6,927 special districts, approximately 870 are fire districts that also have the power to levy taxes.  But most of the remaining 6,057 special districts (60% of all districts) are governed by municipalities.

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