Armchair hospital analysis

July 28, 2018 by Fred Allebach

Many playing local issues have a zero-sum game pattern. The current hospital dust-up fits perfectly. Partisans immediately stake out a position and then endlessly repeat their partial memes. There is precious little indication of listening or learning. There gets to be a lynch mob type of feel. Attack mode is the default. The whole pattern repeats itself with every issue. The other guys can’t possibly have a point. This blinders-on fighting is tiresome but also is a main form of local involvement and entertainment.

Every issue has a big picture element. For example, small hospitals losing viability is a nationally contextualized issue. Parties could step back and see the larger picture, and work to understand the complexities. Housing, GHG emissions, traffic, tourism, UGB, all could benefit from more of a willingness of disparate parties to come to the table with an open mind. Unfortunately, this rarely happens. To quote the Grateful Dead, “you ‘aint gonna learn what you don’t want to know…”

Do we want a hospital in Sonoma? I say yes; a diverse medical economy benefits the community and helps to offset a preponderance low-paying hospitality jobs. Yes also gives 35,000 lower valley people the chance to be served locally. Many of these people are low income and their health would be negatively impacted by having no local hospital. Hospital inter-relations with the Clinic are important here. Finally, who wouldn’t want a hospital? To have such a resource is an overwhelming community benefit, especially if you or a family member had a life-threatening emergency where minutes to the ER really count. I know because minutes saved a very loved one’s life here five years ago. Thank you Schell-Vista and SVH ER! Bottom line, increased transit burdens mean decreased healthy outcomes.

The Sun editorial board supported the last parcel tax. The parcel tax is public funding for a good public service. People keep hammering away on this tax as if it was an unreasonable burden. What we get in most parcel tax public comment, is an absence of understanding of the big picture, that the parcel tax offsets monies that the hospital spends to carry the Medi-Cal poor, our poor. Medi-Cal does not pay a full boat of what services cost. Basically, the parcel tax is an effort by locals to handle a national health care funding problem ourselves. The partial and inaccurate parcel tax meme is to conflate it as a full cure for all hospital budget issues. I see regressive anti-tax forces at play here, and maybe also class and race discrimination.

If we do want a hospital then the next step on the flowchart is how to make it work, how to make the financials and services work? First of all, you can’t be losing money on particular services. During the last parcel tax process, hospital board member Bill Boerum made a strong point that specialty departments need to be cultivated that make money and in turn, keep the hospital open. The idea was we wouldn’t need the parcel tax if the hospital had some big money makers. This was an economic common sense argument. Now Boerum wants to preserve a department that is losing money. What is Boerum really about here as a board member?

Another charge is that hospital administrative salaries are bloated. This has been shown to be not true. Executive salaries are mid-range for similarly sized hospitals. Sure, salaries seem like a lot, but let’s look at a similar salary debate from Valley of the Moon Water District as an example. On a VOMWD meeting agenda item about whether or not to give raises and to pay competitive wages, board member Ron Prushko staked out the same kind of bloat argument we now see from some with the hospital. VOMWD staff argued that to retain qualified personnel, and to not spend tons on training and then have employees leave for a better paying job, that it is worth it to pay people the industry average.

So, if at the hospital, you want to be super frugal like Mr. Prushko, and keep financial outlays trimmed hard at the salary level, then you end up with quality, performance, and employee attrition issues on the other end.  This is a budget priority issue that has certain values hidden underneath. For some, it’s efficient and not unreasonable to at least shoot for average pay. At a basic level, a lot of this bloat stiff amounts to being penny-wise but pound foolish. However, I do agree that when looking at executive salaries of all types, they seem way out of proportion to regular life. Why can’t executives take a cut too when they are making so much ad thr system is burdened by increasing costs?

My opinion: A financial analysis process can’t start from a weasel word like bloat, and then have all numbers get lined up to prove that foregone conclusion. Numbers are made to be manipulated, and as with all else, the important question is: what are the values behind that are trying to be expressed obliquely through budget priorities? Do we want a hospital? What are the big picture health care issues that are comng to bear with our local hospital?

What I see with the latest hospital issue is a lot of emotional arguing, where mostly smart people act as if the merits of the case can only pan out along the ways they see as true. This is the same metaphor I used on the hillside homes issue: alternate universes of facts colliding. This is what happens when all local issues become a habitual zero-sum game, which is the apparent default issue engagement pattern in Sonoma.

As for tiresome, there’s really no sense in arguing, as I think people are realizing; no one who disagrees listens anyway. Locals have backed off the I-T comment section as a lair of formulaic trolls. Facebook ends up being actors sequestered off and preaching to their own choirs, people on FB also tired of downward spiral arguing. Which local actors here can bring the hospital discussion to a higher level where the core common issues at stake can be laid out for all to see, rather than exploit divisions for ideology, entertainment or personal gain? I don’t have all the hospital specifics myself, but I do know that many have points to make, of which there is probably some element of truth to each. How to put these pieces together so the community as a whole can see how hospital issues make sense?