Coast Hospital Tax Maneuvers

You know there is a problem when you type the following phrase into your search engine, 'Is free cell solitaire an addiction?' and all that comes up is page after page of differing versions of free cell solitaire. If you truly need help, the only answer is endless variations of your addiction.

Pretty much like the health care dilemma in the good old U.S. of A. The sicker we get (see numbers on obesity, diabetes, and more or less any self-inflicted calamity known to man or womankind) the bigger mess we allow to be made of our overall health care system.

Not that we aren't granted little nibbles of hope. The Affordable Care Act (ACA — what most Americans, in our short attention span glory, can only recall as “Obamacare”) allows us to switch insurance companies without being penalized for our previously existing medical conditions. On the other hand, if you think large insurance companies and Big Pharma haven't profited while the ACA has been rolled out, well, then you probably don't know much about health care finances let alone that Burl Ives played Big Daddy in the film version of Cat on a Hot Tin Roof.

Health care, in general, is indeed a mess in this country, and yet there are doctors and nurses doing their level best all over the place. They just get re-wound every so often, like an old watch that's supposed to keep on ticking no matter how much you use and/or abuse it. Ten to fifteen years ago the medical profession admonished its practitioners to honor pain relief for patients. Today the pendulum has swung the other way. Even senior citizens who have never sniffed a mimeograph let alone had a problem with booze, marijuana, cocaine, or heroin are being pee-tested and asked to sign a contract in order to get their next dose of pain relief from excruciating rheumatoid arthritis. Tough love has found the land of the dope grower and the home of the weed; on the Mendocino Coast a good opioid is hard to find.

I come not to praise medicine, but to question how it can afford to go onward at Mendocino Coast District Hospital. The answer may in part lie in the “California Medi-Cal Hospital Reimbursement Initiative” which will be on your ballot, not in June, but during the November general election.

A little background to get us to said initiative. The federal government's Medicaid program helps pay for health care services provided to low-income patients. Mendocino County has a whole bunch of those/us folks.

This program is called Medi-Cal. For California to receive federal Medicaid funds, the state has to contribute a matching amount of money. In 2009, a new program was created in which California hospitals were required to pay a fee to help the state obtain available federal Medicaid funds. That program has resulted in California hospitals receiving about $2 billion a year in additional federal money to Medi-Cal. However, year after year the state has been diverting a higher and higher percentage of these Medicaid matching funds away from the hospitals and into the state's general fund. Currently that diversion amounts to more than 20% of the matching Medicaid money. If passed by the electorate in November, the “California Medi-Cal Hospital Reimbursement Initiative” would not only continue the funding more or less in perpetuity, but cap the state diversion of Medicaid funds at 24% permanently.

The catch for Mendocino Coast District Hospital (MCDH) is that currently it is not in the aforesaid reimbursement system. This is what the latest brouhaha at MCDH is about. The major item of new business at the Thursday, March 31st MCDH Board of Directors meeting was a telephone presentation from attorney Lloyd Bookman (from the firm of Hooper, Lundy & Bookman).

According to Bookman, in order for MCDH to become a recipient of the Medi-Cal “Provider Fee” program the now public hospital would have to become a private non-profit hospital whose day to day operations would be under the direction of its own non-profit board. Presumably the non-profit board members would be appointed by an overseeing Board of Directors who would still be elected by the public.

In order for that process to take effect the Mendocino Coast District Hospital voting public would have to approve the change. At the March 31st meeting, no one asked directly whether or not the hospital's employee union would have a yea or nay vote on the matter.

MCDH Chief Executive Officer (CEO) Bob Edwards and Chief Financial Officer (CFO) Wade Sturgeon are touting anywhere from a $3 million to $6 million gain in funding over the current methodology employed at MCDH. At one point Sturgeon asked Bookman if the new system would allow MCDH to keep all of the parcel taxes it collects annually. Somewhat cryptically Bookman replied that MCDH would continue “to receive a portion” of its taxes. Neither Edwards or Sturgeon nor anyone on the MCDH Board of Directors followed up to ask what that portion might amount to.

The considerable number of people in the audience (mostly hospital staff) were not allowed to query Mr. Bookman. This leads us back to the MCDH Planning Committee meeting from the prior week. At that gathering a letter, either from Mr. Bookman or a competing legal team, concerning the hospital reimbursement program was discussed at some length by CEO Edwards and other members of the Planning Committee, including Board members Kitty Bruning and Peter Glusker. When this writer asked for a copy so that the public could read about the letter and its contents, CEO Edwards more or less leaped to his feet, declaring, “Trade secrets.”

In an email to this correspondent later that day, Edwards added the phrase “attorney-client privilege” to the “trade secrets” claim. This should continue to make the public wonder why the voting public of the Mendocino Coast Hospital District cannot be privy to information about an issue they may very well be asked to vote on?

When logic and proportion

Have fallen sloppy dead

And the white knight is talking backwards

And the Red Queen's 'off with her head!'

Remember what the dormouse said

Feed your head

Feed your head.

I'm going to move the red queen onto the white knight and beat this darn free cell yet.

(Malcolm Macdonald's website is: MalcolmMacdonaldOutlawFord.com.)