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The Coming Storms…

December 23, 2009

One reason I believe that forces supporting the Music City Center are pushing so hard at this time is a recognition that we are in for some very dark times in the days ahead in regard to setting priorities for government spending. While last year’s 10% cuts were certainly difficult, I am quickly discerning that they will seem like a piece of cake compared to what is to come, especially since none of our leaders has the will to speak the truth that we cannot provide the current level of services we receive without increasing income. Of course, the pro-MCC forces will suggest that building the convention center is an investment in “broadening the tax base” (meaning getting the visitors to our city to pay for the things that we want and need), but that the payoff on that investment won’t be realized for several years in the most optimistic scenarios, and the financial problems we face are right here.

For the past year, I have been engaged in advocacy for the Metro General Hospital and the Nashville Hospital Authority system. I come to this work in the belief that a world class city maintains some responsibility to its citizens for ensuring that all persons receive essential health care regardless of one’s ability to pay, and Metro General is the means that our city uses as a safety net for indigent care. This essential city function has been affirmed for me by the most conservative of hospital administrators and the leaders of our large teaching hospital, with the for-profit sector fully admitting that they can’t offer the services that Metro General can, nor are they willing to “pick up the slack” should Metro General go away. Our city provides a subsidy for indigent care which represents less that 3% of total city expenditures, and does not fully cover the needs of the hospital.

Metro General has received a fair share of criticism in the past for being poorly run, however in the past four years the hospital has turned that around and is being run as efficiently as any hospital in the nation. They are holding their own financially in spite of being underfunded by the city, due primarily to a patient base covered by TennCare. But as our governor has been hinting, state revenues continue to be down and their is even more pressure to dismantle TennCare even more than as already been done.

So, if current state budget projections continue to hold, Metro General will lose around $10 million dollars in state subsidies for indigent care. Even scarier is the proposal (not yet acted upon) to cap TennCare reimbursements for treatment to $10,000 per year for all patients, an amount that for most people represents one three or four day hospital stay.

I was told by an administrator of one of the state’s public hospitals that Dave Goetz, the state director of finance, stated that the public hospitals in the state (primarily The Med in Memphis and Metro Nashville General) will likely have to close down due to the decreases in funding and the projected levels.

And friends, closing down these places is not without consequences. The fact is that people will indeed die due to lack of care or inadequate care. The for-profit and teaching sector cannot pick up the slack, nor do they want to. People will die because we as a people have been unwilling to spend a couple of bucks to keep them from doing so.

This is just one of the issues that we are facing in the coming year, and there are those in our city who aren’t willing to talk about the future to come. And yet, we are going to have to make some difficult decisions in the days ahead. Putting our heads in the sand as if these problems aren’t out there only ensures that the decisions we make in the future will be made in the heat of the moment, fraught with emotion, and probably less reasoned than they should be.

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2 Comments leave one →
  1. December 23, 2009 1:26 pm

    Jay,
    This is very interesting insight. It makes the health care debate in DC all the more relevant to local communities, especially the costs of medicare and the state networks such as TennCare. Apparently the potential for abandoning public hospitals is nationwide. The charity hospital system in Louisiana is going to be affected by the national health care plan. See the NY Times coverage here: http://www.nytimes.com/2009/12/20/health/policy/20louisiana.html

    These decisions present us with the occasion to re-establish community responsibility after several decades of movement away from it. As you correctly point out, medical care is only one service. Public funding for our schools, roads, infrastructure, It will take leaders who are willing to speak forthrightly and take on the resistance to taxes, special interests and privatization that has not always served us well in these areas.

    Thanks.
    Larry

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