How many times have you read articles that refer to “cities and states,’ as though those two entities cover the waterfront for the broader term “local government”? Often, we’ll bet. But whenever we see references like that, we immediately wonder, “what happened to the counties?”
There are over 3,000 counties (or so-called county-equivalents) in the United States with some 3.6 million employees, and they are at the center of many of the functions that Americans think of as government roles, just beginning with courts, jails, health care, education, transportation and human services. They range in size from itty-bitty ones like Loving County Texas with a population of 64 to Los Angeles County California with almost 10 million residents (that’s more people than in the ten smallest states combined).
It's long interested us to see how many well-educated friends of ours have been almost entirely ignorant of the significance of counties. This may be largely explained because many of them are from New York City, and so aren’t living in a part of the country where the word “county” comes up very frequently or in Connecticut, the one state that doesn’t actually have any counties at all, except for those that serve as geographic boundaries on maps.
We became even more acutely aware of just how much counties could be the center of a pressing issue, yet still kept out of the loop when we co-authored a white paper with Don Kettl for the IBM Center for the Business of Government.
As we wrote, “Though counties represent the level of government that tends to get the least attention, they have historically served as the cornerstones of health policies, including immunizations that keep diseases like diphtheria, pertussis, and measles at bay. Yet when the Centers for Disease Control and Prevention issued a playbook to guide vaccination distribution in October of 2020, counties barely received a mention.
“Not only did the federal government fail to communicate effectively with the counties, but the states often lacked similar actions. This left many counties swimming upstream as the (vaccine) rollout began to move forward.”
With all this in mind, we were particularly eager to read a new book that has just come out called Governing on the Ground: The Past Present, and Future of County Governments that helps put the importance of counties into perspective through a series of essays by people who make the counties work. The essays, written in first person, give readers some perspective about the heroics and heartbreaks of county leaders from coast to coast.
Typical is the moving story of Douglas County Nebraska Commissioner Mary Ann Borgeson who was put in the painful position of becoming a caretaker to a mother with Alzheimer’s disease and a father who was diagnosed with cancer. “It was a grueling schedule,” she writes, “because I was also looking after my husband who was being treated for cancer. Sometimes, my husband and Daddy were at the infusion center together, not a family outing I’d wish on anyone.”
She writes about her efforts in Douglas County to help others who were in similar positions, by trying to ensure that there were enough people to serve in positions as “drivers, home-health aides, housekeeping, you name it. . . “
The county couldn’t turn its back, and so, she writes, “We just looked for new ways to provide the services and made sure our elderly received their food deliveries and medications. For doctors’ visits, we used telemedicine, and to see how our residents were faring we checked in via Zoom. Technology, while not a solution to the staffing shortages, improved our outreach. Communication is key to accomplishing this. You have to make certain that you are providing the services people want and need. You also have to stay in touch with the private providers to find out where they are running into trouble, and with your state and federal delegations to see that you have the funds to pay the providers.”
This is only the beginning of the work that Douglas County does to help serve its older residents, and like many of the other essayists in the book, Borgeson tells the story well, and with humanity.
As Matthew Chase, CEO and executive director of the National Association of Counties wrote in the forward, “County leaders are on the front lines. When a road needs repaving, a family member overdoses from a fentanyl-laced substance or nursing-home patients are overwhelmed by COVID-19 residents expect results. They care about their potholed ruined tires or whether their loved ones will survive the virus. End of story. No debate about it.”