Tuesday, November 11, 2014

Talkin' hospital blues

 I prefer to restate the obvious, but sometimes if no one else will make the first move, I feel I have to do it myself. But until  last night, it was always on the blog. Last night for the first time, I testified at a public meeting.

The House Health Committee held a public hearing on the deteriorating financial situation at the hospital. About a hundred people spoke.

Some spoke of the future and some of the present. Only one person spoke of the history of the crisis. Here is what I had to say about that. I have the impression the legislators didn't like it much:

Good evening. My name is Harry Eagar. I am retired now, but for 25 years I was the business reporter at The Maui News. I am going to give you a history lesson and an ethics lesson.

In the early ‘90s Maui Memorial was throwing off substantial surpluses. It needed to reinvest this cash in new medical technologies and expansion to deal with a growing residential and visitor population. It was prevented by an Oahu-centric Legislature that looted this surplus to support deficits at state hospitals in places like Lanai and Kona.

Ethically this was unjustifiable. Hawaii is an island state with several remote, rural localities. It was not the place of the customers of Maui Memorial alone to cover the deficits of the rural hospitals. All of us in the islands are an ohana, and it is the duty of all of us who are more favorably situated to help provide basic public services like roads, schools and hospitals in places where local revenues cannot cover the whole expense. That is, the ethical course would have been to cover the shortfalls from the general fund.

It is easy to understand why the Oahu legislators did not do this. Using the general fund would have meant less money for them to spend on projects in their local areas.

The decision was not only unethical. It was stupid management.

By starving Maui Memorial, it weakened our hospital and eventually eliminated the surpluses that supported the small hospitals. Now you need to find money to support all the hospitals.

The answer is not the fantasy of Dr. Kwon’s so-called free private hospital. Building that would have completed the ruin of Maui Memorial, but there was a service never intended to be provided by Kwon’s project: mental health care.

Again, it would be unethical to deprive a whole island of hospital mental health services. And you have now learned, from the disgust at the closure of Molokini Unit, how unhappy the voters would have been to have learned that Kwon had eliminated mental health hospital care on Maui.

I am skeptical of the prospects of a public-private partnership as a rescue for Maui Memorial. We can easily guess what the private partner would want to do: recommend shutting down unremunerative segments of care. Like hospital mental health services.

For patients, it would be as bad in the long run as a private hospital, it would just take a few years longer for the disaster to occur.

The time is now to cough up the hundreds of millions that were untimely drained from Maui Memorial and take the steps that ought to have been taken two decades ago.

It will probably require new taxes, which I know can be found; and new backbones, which I am less certain of.

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