Sitting here on a Saturday watching All the Kings’ Men, I am listening to the Willie Stark speech where he promises his voters the “best hospital money can buy,” which was the price of the deal he made with the state’s money men to get elected. They got their hospital, and he became the boss, for a while, which is all any of us have.
The implication, watching that movie, is that Willie Stark sold his soul. After the recent years of the healthcare debate, I see it differently. At least he got “the hicks” a functional hospital, fully funded, that wasn’t used as a political football among career politicians like our local UF Health Jacksonville, aka Shands, is.
The other week, I sat in the UF Health/Shands budget review, in which UF Health Chair Russ Armistead and Lenny Curry’s new CAO, Sam “The Godfather” Mousa, discussed the dire straits of the local safety net hospital’s finances. A few things jumped out at me.
One of them is that the big root of the hospital’s problems was its decision to buy its physical facility. It’s not an asset that can be liquefied, for one thing. For another thing, the hospital has about $80M in capital improvements that must get done. But the hospital can’t do that.
Shands — the only local safety net hospital — has a problem. Duval County has a 19 percent uninsured rate: 145,000 people. With the Exchange, the number may have dropped to 135,000. About 10 percent of the uninsured are covered by the city contract, but 100 percent of them believe Shands is their hospital. Most of the uninsured are working poor.
That contract is a net loss for Shands, year after year — $34M last year.
51 percent of UF Health/Shands’ business is Medicaid; double that of other hospitals in the county. “If we had 25 percent commercial business, I wouldn’t have the crisis that I have each year. Other hospitals … don’t treat the volume of uninsured,” Armistead says.
This puts them in the position of what is delicately called commercial “overcharge,” basically soaking other customers to pay the bills of the uninsured.
Tallahassee has been playing games with Shands’ budget for the last three years, according to Armistead, which has been a struggle. Another struggle is that other hospitals send their indigent patients to Shands; one apparently even distributes helpful handouts instructing them to go there.
Shands somehow makes a profit each year but, as Armistead says, “it’s on the razor’s edge.” The hospital has to run at a better margin. To help that along, a funding solution has to be found.
Tax increases, sure. Property and sales, and maybe an impact fee to hit area hospitals, would all be options if our politicians were willing to use the bully pulpit to get it done. One of the problems with Jacksonville having a crippled left wing is that a Democrat like Alvin Brown couldn’t even be pressured to advance genuinely populist solutions before his political capital became lowercase. Even if Lenny Curry wanted to push in that direction, he would run up against a city council who wants to turn off the faucet.
The fact of the matter is this: Down in Miami-Dade, the city kicks in to keep its public hospital functional. There are benefits in that which extend beyond the balance sheet. The kind of people who work at a safety net hospital are mission-driven. That said, though, they are not mendicants. They have the right to expect a secure framework in which to ply their trades. Part of that security involves not having very toxic, public fights about their funding breaking out among politicians, who always seem to be looking for new and creative ways to extend cut-rate social services.
Jesus said, allegedly, that the poor will always be with us. That is especially true in Jacksonville, where there are several neighborhoods with double-digit unemployment. The model of healthcare has changed in this country forever, just as the culture has changed. If Shands closes, those people who rely on it now are not going to mysteriously get better and not need healthcare. No, what will happen is your gunshot victims and your poor folks and your convicts will be sitting beside you in your private hospital ERs. Your healthcare will get worse. To stop this from happening on the back end, a solution must be advanced on how to pay for this stuff on the front end. Why not start with a fast food surcharge and go from there?