BY JERRY STERNBERG
Forgive me if I can’t hear the “huzzahs” and the “hoorays” for the news that our Mission Health will be sold to HCA Healthcare.
I am grateful and proud of the many folks who have served voluntarily on the hospital board and given so much of their time, money and effort. They have developed one of the best medical service centers in the country, and I am not trying to be critical of the decision they have made to choose this option.
Having been there, I respect the fact that only the people who stick their neck out to serve in our community receive criticism.
However, this transaction goes to the very heart of our health care system in our region, and I think that in the aftermath, there are more questions than answers.
I am a businessman, and forgive me if I seem skeptical of the projection that HCA can provide the promised services and make a profit after laying out $1.5 billion in capital costs and additionally pay some $15 million property taxes just in Buncombe County each year.
HCA claims that they can do this through the synergy of its huge purchasing power for equipment and supplies. I haven’t looked at its budget, but it seems to me that the greatest percentage of its operating cost is wages and benefits. Considering HCA is also buying several large medical practices with highly paid physicians and medical technicians as part of the Mission Health package, is it going to cut back on personnel to make this work? It is already tough and time-consuming to get access to much of the care that is available.
We recently suffered through a major “pissing contest” between Blue Cross Blue Shield and Mission. Many insured patients temporarily lost their in-network rates for nonemergency Mission Health services, suffering catastrophic expense. Many also suffered the inconvenience of having to travel great distances to find a provider of medical care for themselves and their children that would accept their Blue Cross insurance.
What will happen to the patients when these two big corporate boards with stockholders demanding dividends and CEOs demanding multimillion-dollar salaries are fighting for profits and get crossways with each other?
I understand that a new entity called the Dogwood Health Trust has been formed to manage and distribute the proceeds of the investments in this trust.
I was informed that the failure to provide Medicaid coverage for 650,000 North Carolinians was not the sole factor in forcing this sale, but I am convinced that the heavy burden on the hospital to cover indigent care with little or no reimbursement was a contributing factor.
That is why I find it surprising that some of the first folks appointed to this board are influential people who support our current North Carolina legislative majority, which refuses to allow North Carolina to accept the federal Medicaid expansion grant.
This is like the little boy who killed his mother and father so he could go to the orphan’s picnic.
I would think that it would be absolutely mandatory that this board be highly diverse and eschew the idea that only affluent people can get their head around hundreds of millions of dollars.
Is there going to be representation to help provide funds for services for the African-American, Latino and Native American communities, plus alcohol and drug treatment centers, women’s health facilities, etc.?
The distribution of the proceeds of these funds will be subject to huge pressures from all sides, and if the control gets into the hands of a powerful few, it would be a travesty.
This fund not only has to be managed but equitably distributed, as stated in its original intent.
I can also see the good ole boys lobbying their assets off as to who will get to manage these funds and the designation of the financial repository in which they will be deposited. The winner will reap millions of dollars in fees. What will this selection process be?
Someone also pointed out that if this fund is established, many of the charitable funds — especially down east — that support many of our local human services might decide that since we have our own fund, they will no longer contribute to our local nonprofits.
As we know, the city and county governments are salivating over the fact that if this sale goes through, they will receive an additional $15 million a year in property taxes. How will this windfall be used? Will the money just go into the general fund, or will the city use this to bail out its embarrassing shortfall in funding the River Arts District’s improvements? Will the county use this to bail itself out of the A-B Tech debacle?
As an example, Pisgah Legal Services is advocating that this money be spent for:
• Expanding high-quality, affordable early education for all children.
• Increasing the number of apartments and homes affordable for working families.
• Connecting families to jobs, schools and amenities with frequent and reliable transit.
Many property holders will insist that we use the funds to reduce property taxes.
To me, the biggest question of all is: What is our leverage to make sure this private corporation fulfills its contract? There are some specifics as to their obligations that go out five, maybe as much as 10 years. What happens after that? That time will go by quickly. Just remember it has only been 19 years since we were worried that our whole computer system would shut down at the stroke of 12 on New Year’s Day 2000.
If we have to resort to lawsuits or state regulators, whose laws and whose politics will prevail? In the meantime, will our sick and injured be suspended in medical purgatory for an indefinite period of time until the issues are settled?
If this final decision goes through, we basically lose control of our health system at some point in time.
It appears that we are faced with a complicated Rubik’s Cube. If all the pieces are not effectively pieced together, we could find our medical fabric for the western end of the state ripped and tattered for many years to come.
Asheville native Jerry Sternberg, a longtime observer of the local scene, can be reached at firstname.lastname@example.org.