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With The Recent "Reform" Of The County's Health System, The Cure Seems Far Worse Than The Disease.
By Emil Franzi
THE PIMA COUNTY Board of Supervisors recently voted 3-2
to surrender direct control of nearly one-third of the county's
$700 million budget.
These health-related responsibilities--from Kino Hospital to
Long-Term Care, from Home Health to Animal Control--will be placed
in the hands of a self-selected and self-perpetuating entity called
The Pima Health Care System Commission. This new system is defined
in the resolution, which set it up as "quasi-governance."
There was no public debate over the move, even though it has
been coming for many months and supervisors Sharon Bronson and
Dan Eckstrom, along with Huckelberry, have expressed strong reservations
about its soundness and its effect on representative government.
The guiding force behind the new "integrated health system"
is Supervisor Raul Grijalva, with the support of Board Chairman
Mike Boyd along with Boyd's chief aide, Ron St. John) and Supervisor
Ray Carroll. The move has been billed as "integrated healthcare,"
which it is, and a method to "remove healthcare from politics,"
which cannot be done.
The politics which created this shift in power began some time
ago. The vehicle was a "blue-ribbon panel" whose recommendations
were based around this new, so-called "quasi-governance."
Webster's defines "quasi" several ways, but the
closest would be "seeming" or "resembling."
In other words, what we have here is "sort of governance."
THE POWERFUL 11-member Health Care Commission is selected
as follows:
- One member employed by the County Health System, chosen
by the Commission (Jon Miller, currently the assistant director
of Long-Term Care)
- One member each from the Public Health Advisory Board
and the Kino Hospital Advisory Board, appointed by each body's
president. (Each one, Sharon Reburn and attorney Michael Rollins
respectively, appointed themselves);
- Three members from the Blue-Ribbon Committee as a "transition,"
and selected by that committee to serve for two years, after which
their positions will be filled by the Commission. (Those three
are former TUSD Board member Sylvia Campoy, currently a City of
Tucson employee; Tucson business woman Dorothy Finley; and public
accountant Christine Granillo.)
This group, chaired by Campoy, then selected the other five members,
whom the supervisors also approved 3 to 2. Those five are:
- Retired UA Medical Center employee Dr. Clifford De Benedetti;
- Former Pima County Charter Commission chairman and real-estate
developer Paul Lindsey (who lost trying to sell us similar "quasi-governance"
last year);
- UA College of Medicine faculty member Dr. Joel S. Meister;
- Sheila Parker, deputy director of student affairs in the
UA graduate program in public health,
- Sherrie Schuldheis, a UA research associate and PhD candidate
in nursing,
Nine seats chosen by the Commission itself, two by the presidents
of the two advisory boards--if this all sounds a tad convoluted,
like an old Ernie Kovacs bit involving 38 former mayors of Hong
Kong, the bottom line isn't at all funny: It leaves the elected
Board of Supervisors and their administration out of the loop.
And also note the large proportion of UA types. And further note
the influence of Supervisor Grijalva--Campoy, his long-time political
ally, lost a recent re-election bid to the TUSD Board.
So healthcare comes out of "politics" by having it
led by another politician--and a defeated one at that. Quasi-governance
at its best.
Grijalva says he wants healthcare run by people who know about
it, not a "road warrior" like Huckelberry, an engineer.
But the current system puts Dennis Douglas in charge of the County
Health Department. Douglas, while seemingly capable, is a retired
Sheriff's major.
The resolution empowers the Commission to choose the outfit's
CEO, who in turn chooses the balance of the staff. The current
holder of that exalted position is Dr. Richard Carmona, also one
of the 100 or so applicants for the permanent $180,000 position.
The Commission resolution, under the guise of eliminating "politics"
and ensuring of "non-interference," gives the supervisors
and their management team one clear message: Bug off!
The Commission, through its own finance department, will draw
it's own budget for submission to the supervisors, and will (it
appears) be in charge of hiring all county healthcare personnel.
The commissioners will allow the supes to "make policy,"
but that role will be passive--exercised only concerning items
the Commission itself recommends. Thus, the Commission will have
more powers than elected line officers, whose budgets are reviewed
by county administrators, and whose employees are currently in
the county merit system.
Supervisor Boyd has publicly stated that one problem he wishes
to "correct" for healthcare is the current "outmoded"
personnel policy. So you can expect health employees to be quickly
dumped from the merit system. Carmona has already cut back on
Home Health nurses, downsizing and knocking many back to part-timers
and reducing their benefits. Their complaints have drawn threats
from Carmona to simply contract their jobs to the private sector
and lay them all off--the type of privatization Boyd and St. John
have lusted for since Boyd's election. Campoy, when questioned
by Home Health employees, said she wasn't familiar with the issue.
We thus have the incredible irony of Pima County, with a long-standing
program in Home Health serving the "notch group"--the
working poor who have no health benefits--placing its own workers
into that very "notch group." The problem, we are told,
is that Home Health is "losing too much money."
Well, there's a reason for that: It's a welfare program! What
idiot thinks it's a profit center?
THE ROLE MODEL for this form of "integrated healthcare"
is supposedly Denver, Colorado, where the city and county formed
Denver Health as a separate governmental entity. But as Huckelberry
pointed out as early as last July, there are significant differences
between the Denver model and Pima County's plan. The Colorado
Legislature passed enabling legislation to allow for a transfer
of governmental power; contracts spell out all the details and
allow current employees to transfer from their old merit system
to a new and similar one; and--most significantly--the directors
in Denver are appointed by the mayor with the confirmation of
the city council. They do not get to pick themselves. The Commission's
real role model would appear to be the Tucson Airport Authority,
another unelected and self-perpetuating group that controls a
governmental entity.
An additional problem is left unanswered: The large debt incurred
by Kino Hospital--currently totaling $18 million--that Pima County
has carried for years. In prior years, the supervisors have papered
it over in a variety of ways, usually by having a surplus in other
funds at the end of the year. But the fiscally responsible GOP
majority of Boyd, Paul Marsh and Ed Moore blew that surplus sometime
ago, and the creative bookkeeping is about over.
One reason Denver Health is working is that it began debt-free.
Proponents of Pima County's new system claim the debt is a phony
issue. But Supervisor Bronson thinks it might be relevant when
the bond lawyers rate the county on the issue voters recently
authorized. She adds that bond bean-counters are notoriously leery
of governments that set up bifurcated responsibilities and shuffle
debts. This move could cost Pima County a higher interest rate,
meaning fewer projects--from roads to open-space acquisition--get
done.
Another big question: Who will replace Carmona? Although he claims
he's sacrificing higher pay elsewhere by serving for a mere $180,000
a year, Carmona has applied to keep the job. When the other applicants
discover the system is a can of worms established by a 3-2 vote,
plan on seeing most of them withdraw--at least the better and
smarter ones. And for Carmona it's clearly more than just the
money--it's the power, and the opportunity to be unavoidable for
comment to his sycophants in the local media.
But the biggest problem with this fevered scheme is the shameful
negation of the principles of democracy and representative government.
We've all become disgusted and cynical with our politicians, but
have we gone so far that we'll simply allow them to be replaced
by self-appointed bureaucracies?
The 11 people now in control of the county healthcare system
were not elected. Most of them were not even appointed by an elected
official, and their successors certainly won't be. Is this how
we really want to be governed--by the quasi? How do we get rid
of them if they grow arrogant, aloof, self-serving, or just plain
nasty?
In a recent editorial, the Tucson Citizen wrote, "It
just might work out fine if the Commission stacks itself
with competent members." Monarchy works pretty well, too--when
you're lucky enough to draw a good king. But the odds suck. And
so does the transfer of power from those we choose to those we
don't.
We expect action and accountability from those we elect. We can't
have it if we allow them to be downgraded to onlookers and converted
to potted plants. Voters and citizens are the ultimate losers
in this game.
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