There’s not a single, perfect way to consolidate South Carolina’s many disjointed, uncommunicative health agencies. You could merge every agency that touches even tangentially on health care, or you could leave out, say, the social services or veterans’ affairs offices, as legislation the Senate passed on Wednesday does.

Likewise you could create one completely consolidated super agency from the get-go or leave the six individual agencies largely intact but grouped under a single secretary with pretty much absolute authority, as S.915 and and its companion H.4927 do.

But there’s a perfect way to keep our state’s long-awaited consolidation from happening — or at least a tried and true way: It’s to let one individual agency talk its way out of the consolidation, or even a little piece of it. That creates blood in the water, and the other independent fiefdoms start circling, demanding first small concessions and then complete exemptions, and their legislative supporters start forming coalitions — I’ll vote to keep your agency independent if you vote to keep mine independent — until the entire thing unravels.

This is what has happened every time legislators have tried to bring some sanity to this huge portion of our state government, and every time, we’ve gotten left once again with eight separate agencies that divvy up the job of providing crisis mental health care, physical health care, substance abuse services, disability and special needs services and assistance to the elderly and at-risk — in sometimes overlapping ways, often with no coordination or communication, diminishing the quality of care, increasing its cost and forcing patients to navigate a confusing labyrinth of bureaucratic entities.

And now, just barely one step into the most promising effort ever at consolidation, the House already has yielded to the first request for an out.

The original legislation embraced by Senate and House leaders and Gov. Henry McMaster would have ended the practice of sending $17 million a year in alcohol taxes to the counties for alcohol and drug abuse education and treatment and instead allowed the secretary of the new Executive Office of Health and Policy to allocate that money. That way, the state could get matching federal Medicaid funding that the counties can’t draw down and, more importantly, make sure the money was spent where it was most needed, rather than being distributed on a per-capita basis.

Earlier this month, the Behavioral Health Services Association of South Carolina, a lobbying group for the 31 independent alcohol and drug abuse authorities that serve the 46 counties, started urging legislators to let them keep the $17 million, predicting calamity if they lose the funding and helpfully providing legislators with a breakdown of how much each county stood to lose. And presto chango, the House bill — which was still a skeleton when the lobbying began — suddenly emerged with no reference to redirecting the money.

Senate leaders initially refused to budge. When the Senate agreed Tuesday to let the counties keep $12 million, it was only after Sen. Tom Davis discovered that the current law was being read in a way that gives the agencies much more money than he and other authors of the bill realized, and urged the Senate to reallocate only the $5 million they had thought they were targeting.

Now, it’s possible that the House will agree to the Senate’s approach, but it’s worrisome that its initial response to the usual sort of sabotage was to give in. It’s worrisome not so much because changing the allocation for a few million dollars is essential but because lobbyist-driven erosion begets more lobbyist-driven erosion. Until, again, there’s nothing left.

It was clear during the Senate debate that some of the local authorities aren’t happy with the state using any of that money in a smarter way. And their initial volley also complained that the tiny Department of Alcohol and Other Drug Abuse Services was being subsumed into the huge Mental Health Department rather than being held out as a co-equal branch in the new Department of Behavioral Health. The Senate didn’t change that, but the locals still have another crack at it when House debates its bill, likely this week. The House needs to see to it that they fail.

As Sen. Davis reminded his colleagues, this legislation isn’t a solution in search of a problem. Merging the departments of Mental Health, Aging, Disabilities and Special Needs, Alcohol and Other Drug Abuse Services, Health and Human Services and the health side of DHEC is based on a thorough examination by national and state experts who found that South Carolina, with the most disjointed health delivery service in the nation, desperately needs this change because “we aren’t getting the health care outcomes that we deserve based on the resources that we’re putting in.”

It’s time we got the outcomes we deserve, and are paying for. The only way that happens is if we get the law we deserve — without it being scuttled by the usual death-by-a-thousand-cuts assault.

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