Stewards of the Visual Exposition
A few things to consider re. the Hospital
Publisher's Note: This opinion piece on the political swirl that is developing within the gravitational pull of the Beaufor County Medical center was written by the Beaufort Observer Editorial Team (which is mostly Delma Blinson and general manager, Buzz Cayton). This op-ed is a fine piece that exhibits a deep understanding of the predicament that the Beaufort County Taxpayers, represented by the Beaufort County Commissioners, have been thrust into.
We thought the comments from the public at the recent public hearing on the future of the Hospital were, for the most part, excellent. But we must say we don't understand those who have already come to a conclusion about what the best deal is going forward. How can anyone possibly know that? We don't even know what the proposals are.
Yet a majority of the speakers, some on the Hospital board, the Committee of 100, Commissioner Al Klemm and even our friends at the WDN have already concluded that University Health System is the best option for BCMC for the next twenty to thirty years (the length of time that a lease would probably run.) We dissent.
We don't think we have the information to come to that conclusion. And we don't think we will have that information when the proposals are in. It will most likely take some negotiations to work out a deal.
The same is true for those who say independent hospitals cannot survive. How do they know that? How do they know better management would not have avoided the current problems? How do they know if some of the doctors' practices are losing money that it is the hospital that should be sold or leased rather than revise those practices? We have reported here frequently that the accounting system used by the Health System does not track profit/loss to the individual practices and departments. Without knowing that, how can anyone possibly say it is impossible to operate a hospital independently? Pungo does it.
But the argument we find most specious is that a non-profit is automatically better than a for-profit operation. The term "non-profit" is a misnomer. All operations will operate to make a profit. The difference is only in what happens to any profit that is made and how much that profit is. (More precisely the real difference is who controls the profit).
But what assurance do these proponents of UHS have that the "profit" made in Beaufort County will remain in Beaufort County to beef up services? That is yet to be determined, but an issue that will be essential to ascertain in the negotiations.
The same is true of "quality" of health care. By what standard are we going to assess quality? It would seem that this question must be answered before we can assume quality will automatically be improved under any other operator. Is the quality better because an operator is bigger? How is quality to be measured?
And in conjunction with both the quality and profit issues we would suggest that it is a fallacy to assume less competition will produce either better quality or better fiscal performance. Less competition does not usually do that. What exactly do we lose when we lose competition?
If you think about it, "non-profits" don't have a great record for either performance or quality. After all, AT&T was a monopoly until it was broken up. Look at what competition has done for telecommunications. More services at a lower cost. And in health care, remember Blue Cross and Blue Shield is a non-profit and their rates have gone through the roof. We'd bet that most people who have been insured by BCBS can't tell you whether they would be better off or worse off had BCBS status of "for-profit vs non-profit" been different than it is. And the VA is a non-profit but we have heard many horror tales about their service. And of course, Washington Electric is a non-profit. So is Tideland. Surely not all non-profits are paragons of quality at a low cost.
We would suggest the "for profit" vs. "non-profit" thing should be viewed from an as of yet unmentioned perspective...that of the patient. We would suggest that the patients are better off if they have more choices. We would suggest a patient is better off if the provider knows that patient can go somewhere else.
Now a patient can choose Beaufort or Pitt. We think choice is power. Power where it needs to be...in the patient's hands, not in a board room full of people whom most of us don't know who they are or have any influence on how they get their seats at that decision-making table.
And that brings us to the most disappointing facet of the local debate thus far. The major issue we would suggest that the County Commissioners will have to make is "who makes the decisions and under what terms and conditions?" We don't care whether the corporate charter says "profit" or "non-profit," it is the decisions that the governing body and administration make that will determine the quality and cost of health care, as well as the working conditions of the staff.
Suppose the lessee decides to cannibalize our health system to the benefit of another? Suppose the quality of care is much worse? Who is going to have the power to address that problem? Suppose the doctors, employees and/or other providers are displeased? Who goes to bat for them? Surely the employees are better served in a competitive system rather than most all the jobs being controlled by one entity.
The simple fact of the matter, that is not debatable, is that if there are no governance controls on a new operator, be that a "for profit" or a "non-profit," then the people will have no control over how their considerable investment is operated.
Those who think that "non-profits" are inherently better than a hospital controlled by a board that the voters can hold accountable should ask themselves this question: How is a non-profit held accountable for its performance and what it does with the difference between its revenue and expenditures? Remember, the United Way in Charlotte was a non-profit when it spent all that money on lavish salaries. And Frank Ballance and Charlie Rangel operated "non-profits." And even ECU itself is a non-profit and those of us who have worked in that labyrinth know it is not the epitome of efficiency or effectiveness.
Wonder how many votes Beaufort County would get on the UHS board.
A good deal with UHS is imminently possible, but it is not guaranteed simply because it is with UHS. The devil is in the details. But based on the debate thus far and the position some of our leaders have taken we have to say the devil is surely in the half-baked idea that a monopoly is better than competition and a non-profit is going to operate at a loss or that whoever--profit or non-profit--is going to automatically operate in the best interest of the citizens of Beaufort County, who after all own a valuable asset which some apparently are willing to just give away. After all they don't even know what the assessed value of that asset is at this point. So how can they know whether a proposal is fair when we don't know what the asset is valued at or what we are being offered for it?
And consider the time frame. We have speakers saying changes in the industry dictate leasing to a "larger" operator. Yet only a fool would conclude that current circumstances in the industry are what they will be over the next twenty years. What if things change in a year or so (particularly after 2012)? We would postulate that the only thing that is certain about the future of the health care delivery system is that it will NOT be what it is today.
Perhaps some of these speakers need to tell our friends in Belhaven that there is no future for small hospitals.
Perhaps Mr. Klemm, the Committee of 100, the WDN, those on the Hospital board and the speakers who have already decided what the best deal is would explain some of these things to us.
Let us hope that the majority on the County Commission will carefully consider all of the details. And for the leaders who have already put themselves in bed with UHS we hope they will consider recusing themselves from the final decision if UHS is one of the finalists. What we don't need is a law suit against our health system or county for unfair trade practices nor do we need the appearance of conflicts of interest. Could it be that one reason for the fewer number of proposals is that some who would have submited proposals believe the deal is already done? If we are going to discard competition in our health system at very least we need to have as much competition in the proposals as we can get.
Those who decided UHS was the best deal before the cards were played have not done our community a good service.
Delma Blinson writes the "Teacher's Desk" column for our friend in the local publishing business: The Beaufort Observer. His concentration is in the area of his expertise - the education of our youth. He is a former teacher, principal, superintendent and university professor.
Go Back
We thought the comments from the public at the recent public hearing on the future of the Hospital were, for the most part, excellent. But we must say we don't understand those who have already come to a conclusion about what the best deal is going forward. How can anyone possibly know that? We don't even know what the proposals are.
Yet a majority of the speakers, some on the Hospital board, the Committee of 100, Commissioner Al Klemm and even our friends at the WDN have already concluded that University Health System is the best option for BCMC for the next twenty to thirty years (the length of time that a lease would probably run.) We dissent.
We don't think we have the information to come to that conclusion. And we don't think we will have that information when the proposals are in. It will most likely take some negotiations to work out a deal.
The same is true for those who say independent hospitals cannot survive. How do they know that? How do they know better management would not have avoided the current problems? How do they know if some of the doctors' practices are losing money that it is the hospital that should be sold or leased rather than revise those practices? We have reported here frequently that the accounting system used by the Health System does not track profit/loss to the individual practices and departments. Without knowing that, how can anyone possibly say it is impossible to operate a hospital independently? Pungo does it.
But the argument we find most specious is that a non-profit is automatically better than a for-profit operation. The term "non-profit" is a misnomer. All operations will operate to make a profit. The difference is only in what happens to any profit that is made and how much that profit is. (More precisely the real difference is who controls the profit).
But what assurance do these proponents of UHS have that the "profit" made in Beaufort County will remain in Beaufort County to beef up services? That is yet to be determined, but an issue that will be essential to ascertain in the negotiations.
The same is true of "quality" of health care. By what standard are we going to assess quality? It would seem that this question must be answered before we can assume quality will automatically be improved under any other operator. Is the quality better because an operator is bigger? How is quality to be measured?
And in conjunction with both the quality and profit issues we would suggest that it is a fallacy to assume less competition will produce either better quality or better fiscal performance. Less competition does not usually do that. What exactly do we lose when we lose competition?
If you think about it, "non-profits" don't have a great record for either performance or quality. After all, AT&T was a monopoly until it was broken up. Look at what competition has done for telecommunications. More services at a lower cost. And in health care, remember Blue Cross and Blue Shield is a non-profit and their rates have gone through the roof. We'd bet that most people who have been insured by BCBS can't tell you whether they would be better off or worse off had BCBS status of "for-profit vs non-profit" been different than it is. And the VA is a non-profit but we have heard many horror tales about their service. And of course, Washington Electric is a non-profit. So is Tideland. Surely not all non-profits are paragons of quality at a low cost.
We would suggest the "for profit" vs. "non-profit" thing should be viewed from an as of yet unmentioned perspective...that of the patient. We would suggest that the patients are better off if they have more choices. We would suggest a patient is better off if the provider knows that patient can go somewhere else.
Now a patient can choose Beaufort or Pitt. We think choice is power. Power where it needs to be...in the patient's hands, not in a board room full of people whom most of us don't know who they are or have any influence on how they get their seats at that decision-making table.
And that brings us to the most disappointing facet of the local debate thus far. The major issue we would suggest that the County Commissioners will have to make is "who makes the decisions and under what terms and conditions?" We don't care whether the corporate charter says "profit" or "non-profit," it is the decisions that the governing body and administration make that will determine the quality and cost of health care, as well as the working conditions of the staff.
Suppose the lessee decides to cannibalize our health system to the benefit of another? Suppose the quality of care is much worse? Who is going to have the power to address that problem? Suppose the doctors, employees and/or other providers are displeased? Who goes to bat for them? Surely the employees are better served in a competitive system rather than most all the jobs being controlled by one entity.
The simple fact of the matter, that is not debatable, is that if there are no governance controls on a new operator, be that a "for profit" or a "non-profit," then the people will have no control over how their considerable investment is operated.
Those who think that "non-profits" are inherently better than a hospital controlled by a board that the voters can hold accountable should ask themselves this question: How is a non-profit held accountable for its performance and what it does with the difference between its revenue and expenditures? Remember, the United Way in Charlotte was a non-profit when it spent all that money on lavish salaries. And Frank Ballance and Charlie Rangel operated "non-profits." And even ECU itself is a non-profit and those of us who have worked in that labyrinth know it is not the epitome of efficiency or effectiveness.
Wonder how many votes Beaufort County would get on the UHS board.
A good deal with UHS is imminently possible, but it is not guaranteed simply because it is with UHS. The devil is in the details. But based on the debate thus far and the position some of our leaders have taken we have to say the devil is surely in the half-baked idea that a monopoly is better than competition and a non-profit is going to operate at a loss or that whoever--profit or non-profit--is going to automatically operate in the best interest of the citizens of Beaufort County, who after all own a valuable asset which some apparently are willing to just give away. After all they don't even know what the assessed value of that asset is at this point. So how can they know whether a proposal is fair when we don't know what the asset is valued at or what we are being offered for it?
And consider the time frame. We have speakers saying changes in the industry dictate leasing to a "larger" operator. Yet only a fool would conclude that current circumstances in the industry are what they will be over the next twenty years. What if things change in a year or so (particularly after 2012)? We would postulate that the only thing that is certain about the future of the health care delivery system is that it will NOT be what it is today.
Perhaps some of these speakers need to tell our friends in Belhaven that there is no future for small hospitals.
Perhaps Mr. Klemm, the Committee of 100, the WDN, those on the Hospital board and the speakers who have already decided what the best deal is would explain some of these things to us.
Let us hope that the majority on the County Commission will carefully consider all of the details. And for the leaders who have already put themselves in bed with UHS we hope they will consider recusing themselves from the final decision if UHS is one of the finalists. What we don't need is a law suit against our health system or county for unfair trade practices nor do we need the appearance of conflicts of interest. Could it be that one reason for the fewer number of proposals is that some who would have submited proposals believe the deal is already done? If we are going to discard competition in our health system at very least we need to have as much competition in the proposals as we can get.
Those who decided UHS was the best deal before the cards were played have not done our community a good service.
Delma Blinson writes the "Teacher's Desk" column for our friend in the local publishing business: The Beaufort Observer. His concentration is in the area of his expertise - the education of our youth. He is a former teacher, principal, superintendent and university professor.
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