Commission Impossible

'If we're lucky this is a fiscal re-tuning, and not the beginning of "Atlas Shrugged" from our city's largest employer.'

Heh, nice comparison. Book makes for an almost-unreadable novel, but it makes some keen observations on politics.

If I'm reading your post correctly you're alluding to a sort of collectivization of Enloe on the part of its employees.

Hospitals have always reminded me of Atlas Shrugged in a completely different way: They can't refuse service if the patient can't pay. If memory serves, the people in Atlas Shrugged were compelled to work by the government. If Enloe were set in the world Atlas Shrugged, both the hospital _and_ its employees would be forced to provide healthcare out of their duty to society, regardless of compensation. Somebody closer to healthcare--and with a better recall of Rand--correct me here if I'm mistaken. (I'm in healthcare technology.)

The "regardless of ability to pay" rule seems like a recipe for financial disaster at any hospital because, union or no, healthcare employees are generally highly skilled, in short supply, and are therefore expensive. The equipment and supplies are expensive as well.

Perhaps this sort of rule, the requirement to give away an expensive service, only explains part of the hospitals' dire finances. But since you mentioned Rand, I just had to go off on the tangent.

Now that I know what it takes to drag B-Ray out of the woodwork I'll be adjusting my posts accordingly.

I was never able to get all the way through Atlas Shrugged, so I'm no Rand or Objectivism expert. Here is a link to Galt's speech in audio if anyone wants to listen to it.

http://compuball.com/Inquisition/AynRand/galtspeech_pmark_broken.htm

Mostly I was looking at extended attacks on one of our largest local employers and regional healthcare provider. As this organization was trying to plan for an expanded future it was hammered by unions, neighbors, and local politicians.

From the wikpedia link I referenced in the post is this sentence that describes what I was getting at...

"In the world of Atlas Shrugged, society stagnates when independent productive achievers began to be socially demonized and even punished for their accomplishments"

Losing Enloe due to financial sickness would stagger our local economy. Even preventing the expansion of Enloe as a business would reduce our capacity to create new high paying professional jobs. Locals taking pot-shots at Enloe are not to blame for all of Enloe's woes, but they sure didn't make matters better.

Lon

All ya gotta do is mention or imply economics to get me out here!

Oh lordy that Galt speech, I think it runs a hundred pages in the book. It's like a forced march to finish that thing.

Were Enloe to go under would indeed leave this town with a gigantic hole in the jobs market until such time that a new hospital moved in. Not to mention anybody needing the services of a hospital ... I'd like to see Enloe expand as necessary and thrive as well.

Two more thoughts I'd welcome feedback on from anybody--particularly if you work at Enloe or live in the neighborhood--1) I do believe it is possible for employees to financially cripple a company or other organization. I *do not* have any idea whether this is the situation at Enloe; but it's possible for employees to amass enough bargaining power that they make out like bandits in the medium term while imperiling their jobs in the long term. Cf: the U.S. automakers, many airlines.

2) I'm a big fan of property rights and am unfortunately not well-versed in the expansion plan in terms of how much adjacent property Enloe already owns vis-a-vis how much, if any, it will obtain through eminent domain. Where they already own the property I believe they have the right to expand their facility. It becomes trickier where they want property they can not obtain through a market transaction. They're not a for-profit business which weighs in their favor, as do the services they provide and their unique status as the local trauma center. But they could at greater expanse expand facilities elsewhere in the city to avoid taking houses from people who don't wish to move.

Again if they already have title to all the adjacent land, shows you how much I'm reading the local news. The Supreme Court's Kelo decision has just left an uncomfortable pit in my stomach about eminent domain in general.

The helicopter noise issue I come down on the side of the hospital. If you resided in the neighborhood since prior to the helicopter service, that gives one some standing to argue against the noise and in favor of stationing the chopper at the airport. But if you moved in subsequently ... come on. I bought a house directly in the airport's flight path. I don't complain about CDF bombers that circle the area.

Another apt analogy (I fear) will be that of the Aesop classic The Goose That Laid the Golden Eggs.

To hear some folks talk, Enloe could be squeezed for ever more golden eggs, ad nauseum.

Meanwhile, there are piles of documentation on the plight of acute care hospitals across the nation and particularly those in California. There are plenty of empty husks where hospitals once stood. The past 20 years have not been kind to Hospitals. It is not an easy business.

Not that Enloe (or anyone else) should have carte blanche... but, many of the antics in this town have been very damaging to Enloe, and sadly made it less likely that Enloe will remain independent.

Please tell me you guys don't really believe the neighbors and the union are bankrupting a regional hospital?

Didn't the union just get voted in a year ago?

Sounds like you are saying that we better learn our lesson and promise to never ever question a hospital administrator again.

Do you feel like a tool?

TJ,

I’ve thought long and hard about this response. In my world calling people “tools� is a reference to something very masculine. But I assume you meant “don’t we feel manipulated�, because I’m not one to impress my world view on others.

My understanding is that there is more than one union at Enloe, and at least one union has existed for several years. But that’s just a clarification, and not an answer to your question.

In my opinion Enloe is probably facing economic difficulties similar to other institutions in its line of work. When the hospital (which could be considered Chico’s largest employer) sought to expand and plan for its future it ran into concentrated resistance. That resistance could not have been good for its economic health. That resistance also seemed to flow along an ideologically left line

Here’s a long excerpt from Tom Gasgoyne’s CNR that I think explains the whole affair well enough.

“A coalition calling itself the Chico Avenues Neighborhood Association [CANA] hoped to squeeze from Enloe some concessions ranging from building the hospital elsewhere to getting surrounding infrastructure improvements. But CANA came up empty in the end as proponents pushed for no more costly mitigations or project delays.

Of the 70 or so people who testified on one side or the other, the majority were Enloe employees in favor of the expansion, including 10 off-duty helicopter nurses and pilots dressed in blue flight suits and sitting together to show their support for the project. The neighbors never had a chance of significantly altering Enloe's plans because of the politics and emotions surrounding the issue, though a couple of council members tried unsuccessfully to add a few mitigations in favor of the neighborhood.

Council members Maureen Kirk and Steve Bertagna, who are running against each other for the 3rd District Butte County supervisor seat, voted to approve all five resolutions, as did Mayor Scott Gruendl, who is running for re-election.

Council members Andy Holcombe and Ann Schwab, who are not up for re-election, voted not to adopt the environmental-impact report but did vote in favor of the other four resolutions, including the development agreement between the medical center and the city.

The votes came after three years of meetings and a neighborhood charette, hosted by a third party, that prodded Enloe into reluctantly making some changes in its plans to accommodate neighbors. But more mitigation did not come forth on this night. It's too costly and not Enloe's problem, expansion promoters argued.�

My point, which I think is valid, is that none of this could have been good for what is arguably our largest employer. For all of the good things that Enloe does as an institution it is sad to see the damage done to it financially, and more importantly the impact it has had on its workforce and reputation.

I thought it was inappropriate to see Scott Gruendl, then mayor of Chico, attending union rallies that appeared pretty rabid. It was sad when he called Enloe undemocratic in his first fundraising letter. I suspect if he had to do it over he probably would have used different language. And as you can see above he voted in favor of expansion which was a good decision.

No, I'm not blaming the unions or neighbors for the loss of jobs. But sometimes you don't know what you've got until its gone. I hope Enloe is not one of those things.

Lon

Mark,

Right-on brother!

Lon

Lon,

I got my definition from www.urbandictionary.com

I would forward you the link but I don't really want anyone to know that I would use a site like that.

You need to read Tom Gascoyne's story about how Jonathan Studebaker complained that the staff was ignoring him and refusing to turn him regularly -- a week later he died of bed sores.

I can't believe I'm hearing a human say that if you can't afford $3000 a day just for a room, you can die in the gutter - shame on you! Enloe turns people away all the time - that's what Neumeister was fired for, some doctor finally squealed. How about that 15 year old kid from Hamilton City - involved in a rollover car accident and sent home with a quick look-over. No fancy machinery for him - a Mexican without insurance. He died that night in his bed of internal bleeding, something that is detectable with one of those blood pressure measuring devices.

I've been turned away from Enloe because my family does not have insurance - "you'll have to sit in that chair over there and wait for someone from financial services...." Meaning, they want a major credit card number or a lien on your house. They didn't even ask me what I wanted, so they didn't even know what it would cost. When I told the woman I didn't have insurance, she just set me aside, like an old glove. Instead of waiting there, I drove to Feather River, received the services I requested, paid, and was out the door in under an hour.

Enloe is not a service, it's a business. Yeah, that equipment is expensive, but how much of it is necessary? When my friend went in to have her kid, they met her at her car and placed a "monitor belt" around her, without a word. Minutes later they took it off because she went right into labor and had the baby within a half hour, everything perfect. Later she found a $600 charge for the monitor belt, which was completely unnecessary, just a gimmick - a doctor can "monitor" the baby by putting hands on your belly or using a stethescope. Her insurance refused to pay so the hospital turned her over to a collection agency. She went to one of those patient's advocacy groups and one letter got the charge dropped - Enloe knew they were out of line, but it took a lawyer to get them off her back.

And I have friends who work at Enloe - that helicopter is abused. I can think of two recent newspaper stories that reported it used for stuff like sprained ankles and hysterical people - people who had the insurance to cover it, I'm sure.

When a hospital gets big, it's about money, it's not about serving your town. I guess that's what Brian is saying too.

TJ,

I love the urban dictionary and have even linked to it in previous blogs. For everyone else here is the definition of "tool" that I think TJ was referencing...

Tool

Best band of all time with Adam Jones on guitar, Danny Carey on drums, Paul D'Amour once on bass but now its Justin Chancellor, and last but certainly not least the vocals and the style that is Maynard James Keenan. Progressive rock band from the early 90's, introduced a lot of new things in music, including throwing time signatures out the window. Albums out:

92-Opiate
92-Undertow
94-Aenima
94-Salival
01-Lateralus

best music ever. period.

Example of use: (some guy) what are you doing?
(TOOL fan) listening to TOOL.

There were some other definitions about not being particularly bright, but I'm sure those don't apply here.

Lon

Juanita,

"I can't believe I'm hearing a human say that if you can't afford $3000 a day just for a room, you can die in the gutter - shame on you!

Nobody said that. That's complete hyperbole.

Enloe is not an endless supply of community money. CANA was asking Enloe to pay for things that the City of Chico is supposed to provide for all its neighborhoods.

The union negotiations were about money. Enloe has shown (by laying off 179 people) that it has money problems.

I think if Tom Gasgoyne tried really hard he could also do a story about somebody saved by Enloe. But that won't sell papers. And it doesn't meet the big corporations are evil blueprint.

When Enloe is purchased by Kaiser Permanente and some of its specialty services are consolidated with Sacramento I'm sure we'll all have reason to celebrate. Maybe we could carpool down for our frontal lobotomies.

Lon

You're right, I'm sure this misunderstanding could be explained. Just exactly what was Brian saying? He said Enloe has money problems because they can't turn poor/uninsured people away - that's wrong, they turn people away all the time. And what was he saying? That poor people/people who won't be had by insurance companies should just go away?

Juanita,

I honed down your post a bit because I think you made some of your points earlier.

Brian was referring to my reference of Ayn Rand's "Atlas Shrugged". In Atlas Shrugged the world lives off of the productivity of a few, and when those few decide to quit contributing to society things fall apart.

What I read from Brian's comments was that providing for free the service that you earn money from is an economic problem. There was no black and white denunciation of providing healthcare to poor people or the uninsured. A hospital's requirement to treat somebody who can't afford their service I think extends to emergency room visits. For ongoing healthcare I believe you would need to be involved in a government managed program. But I don't work in that industry so don't take that as fact.

Ayn Rand made a philisophical argument by looking at an extreme. We could do the same with this discussion.

If I were to receive the same healthcare for $500/month as somebody receives for free what would be my incentive to pay? Why would anybody pay? And if nobody paid what would be the state of healthcare? That example describes a "business model" problem for hospitals.

On the other extreme we could look at the societal responsibility for healthcare we have to the poor and uninsured. What if hospitals only cared for the wealthy? Would it be sane for our hospital to check your insurance at the scene of a car wreck before sending out a Life Flight to save you or your children? Absolutely not.

So where's the optimum middle ground? I don't think anyone here is pretending to have the answer to that question. If you have health issues any discussion of "middle ground" would seem callous. That's true if you're in managed-care or uninsured. And I recognize that.

What I can point out is that if you are employed at Chico State you will pay about $150/month for healthcare similar to what a self-employed person pays $600/month for. Consolidated bargaining power seems to have worked for them.

Maybe we should form a union?

Lon

>>If I were to receive the same healthcare for $500/month as somebody receives for free what would be my incentive to pay? Why would anybody pay?

well, don't look now, but whenever you pay any of your utilities, soon to include Cal Water, you are paying for those who can't afford to pay their utilities. You also pay a maximum 5 percent utility tax that goes into your city coffers to be spent at the will of the liberal council.

Your incentive to pay is the same incentive you have not to kick a lame dog or not take candy away from a baby. Or pay your taxes, or your insurance bill. Where do you think your premium goes every month? Do you get a refund if you don't make any claims? No, it goes to pay for somebody's liposuction.

Sometimes I think the folks who run the hospital are without any morals. Yes, they look at your insurance before you are life-flighted - that bird costs nearly $1000 a trip, who do you think pays for that? When that CHP made a badly thought-out U-turn on Hwy 99 and broadsided an innocent citizen driving down the road, he was life-flighted with a broken collar bone and a back injury. The woman injured in the other car was left to cool her heels alongside her demolished car, waiting for an ambulance. I guess he was a CHP and more important than her or something.

By the way, when he arrived at Enloe, he asked to be transferred immediately.

>>What I can point out is that if you are employed at Chico State you will pay about $150/month for healthcare similar to what a self-employed person pays $600/month for.

Well, excuse me, but I think you just stumbled onto something there Lon. The insurance companies ARE THE PROBLEM. If you aren't an organization, you get screwed? Garamendi just busted State Farms and Allstate for charging excessive premiums, premiums that did not stand up under scrutiny of their actual payments. Feather River Hospital is "rearranging" their workforce - removing employees from the emergency services because insurance companies are falling behind in their payments for services rendered - not because FR is charging excessive fees, but because the insurers are just not paying.

In the aftermath of 9-11, after telling us they were bracing for record losses, Allstate posted a 35 percent increase in profits - they explained to their stock holders that even though they lost the big bucks in New York (which later proved false), they raised premiums all over the rest of the country. To the tune of a 35 percent increase in profits. There you are - if you have insurance, you're lining the pockets of the rich.

The problem is, doctors expect to get rich for helping people. They claim it's because they spent so much on medical school, but let's see an accounting of that. And insurance companies are a for-profit operation instead of a nest-egg to provide for emergencies. Our healthcare priorities are completely screwed up.

Thanks for being so civil - I'm sorry if I sound like a bitch when I'm arguing.

So if you don't pay for your own insurance it's like you're kicking a lame dog or taking candy from a baby. Got it.

Lon

(flame off Juanita, I'm just kidding)

Wow. This thread's growing like a weed.

[Juanita wrote: ]You're right, I'm sure this misunderstanding could be explained. Just exactly what was Brian saying?

Lon responded with many of the points I would've made, but my initial comment concerned somebody passing a law requiring hospitals to provice service regardless of ability to pay, while (I assume) providing no money to pay for the service. I should've included the second and implied half of this thought to clear things up.

Now the fact that Enloe has turned you away for lack of insurance kind of craters my point to begin with. Have I subscribed to some sort of urban myth; there really is _no_ such law requiring a hospital to give away healthcare service? If anybody in healtchare or law could set me straight on the law's (non)existence I would be much obliged.

That was what I was getting at, the situation described in Atlas Shrugged. Unfunded mandates. If a law requires one to give away goods or services to those who can't afford to pay for them, then the law should also provide funds to defray your cost.

Applying to the current situation: subsidies to those who can't afford insurance.

[Juanita wrote: ]Enloe is not a service, it's a business. Yeah, that equipment is expensive, but how much of it is necessary?

Uh, again I'm not any kind of clinician but if you have, say, cancer, I'm pretty sure you'll want the hospital to have some very expensive imaging systems on hand, along with a lot of pricey chemo meds in its pharmacy. Some sharp and well-paid oncology nurses and docs as well. My guess is that very expensive equipment has helped save or prolong the lives of a lot of patients.

[Juanita wrote: ]When a hospital gets big, it's about money, it's not about serving your town. I guess that's what Brian is saying too.

No, that's not what I meant.

Whether it's a big hospital or a small hospital, it needs enough money to pay for staff, equipment, and so forth. That it needs in the long term as much or more money coming in than it pays out isn't an attribute of its size, mission, tax status, how it is governed, etc. No individual, partnership, co-op, nonprofit, or corporation can run in the red indefinitely. (I do not know if Enloe is in the red, or risks running into the red in the near future.)

Making money isn't the hospital's only concern. If it were, it'd be a cosmetic surgery facility. Can't imagine too many plastic surgery practices are unprofitable.

Money's important though, there is no way around it. Without enough of it, Enloe won't be in a position to provide healthcare to anybody--poor, middle-class, or wealthy.

Brian,

The Emergency Medical Treatment and Active Labor Act is a federal law requiring emergency medical treatment for people regardless of citizenship or ability to pay. It was passed in 1986.

California may have a law that exceeds the level of service EMTALA requires. But the federal law would be a baseline requirement for emergency medical care. There is no mechanism for reimbursement to the hospital for services provided under the bill.

I would imagine hospitals have creative ways of minimizing the impact of the law. Juanita probably touched on some of those. As with all laws it is the body of case law, and not the law itself, that supports specific requirements of implementation. I have no idea what case law backs this legistlation.

http://en.wikipedia.org/wiki/EMTALA

Lon

[Lon wrote: ]The Emergency Medical Treatment and Active Labor Act is a federal law requiring emergency medical treatment for people regardless of citizenship or ability to pay.

Thanks for saving me from getting up off my lazy backside to actually research the topic.

Ok, it concerns emergency services. That clears up my confusion a bit as I have heard of experiences like Juanita's, particularly when an area has both a private or a nonprofit hospital and a county or municipal hospital.

Well, thanks for keeping it lively - great discussion. It's so nice to disagree with you people.

Hey, did you see the letters section today? Vern the Byrd kicks assky! Go Doug! Those two curmudgeons are worth 10 of me - ta ta for now - the nagon mothership is circling the galaxy, scouring the area for dirty laundry and misplaced dishes. And just generally scouring the area - hey, who let the dog in!!!!! - over and out....

FYI:

I've been told offline that the cost for insurance for a family of a CSUC employee is closer to $65/month, and the equivalent insurance coverage for someone self employed would be nearer to $1200.

Lon