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April 13, 1999


Hey, Would You Believe it!? Robin Hood Works For The Mobile Register

The Mobile Register, in its April-4 editorial, has discovered a ready and easy way to solve the indigent-care problem plaguing the USA's hospitals--rob from the rich to pay for the poor! Of course, they didn't come right out and say so. No, they claim they're only concerned about all parties fulfilling their obligations to treat the indigent.

As the Mob.Reg. sees it, three parties are obligated to solve the indigent-care problem: USA's hospital system, USA's endowment Foundation, and Mobile County and surrounding counties. But the editorialist knows quite well that while the hospital system might be able to tighten its belt some, that won't come near to solving the problem. What the editorialist takes great pains not to say forthrightly is that the County is responsible for indigent care and that the County is not contributing its fair share to the hospital system. Instead, the editorialist creates the impression in the mind of readers that since the USA Foundation is "flush with cash," it's perfectly okay to appropriate and redistribute that cash to pay for indigent care. The editorialist opines: "As long as the USA Foundation is flush with cash, it's going to be difficult to convince taxpayers that they need to reimburse the health foundation....USA leaders are going to have to negotiate that land mine, and the endowment foundation's deteriorating relationship with the university, if they hope to get the financial help they now seek." (4/4/99) This opinion mimics that of County Commissioner, Gary Tanner, who believes "the wealth of the USA's endowment will make it more difficult for the medical school doctors and hospitals to convince Mobile County residents that they should pay higher taxes to pay even more for indigent care." (Mob.Reg., 3/31/99)

There are two things here that appear to be connected, but aren't. First, the claim that the Foundation's relationship with the University is deteriorating. Yes, there are problems, but why label problems as deterioration? The University badly needs more money, and the Foundation is very reluctant to give it for some credible reasons of its own, but what does this dispute have to do with the indigent-care problem? Nada, nothing. The USA Foundation has no obligation at all to provide money for indigent care. If Foundation "cash" should go anywhere besides keeping Primehealth afloat, it should go to the university to help it with its current financial problems brought on by circumstances beyond its control. It's an outrageous impertinence for the Mob.Reg. editorialist to insist that USA endowment money should be spent to alleviate the indigent-care problem which is desperately in need of a long-term solution through county-wide taxation. Charles Baugh, the Dean of the College of Medicine, said "the problems suffered by other medical schools are magnified in Mobile because the university receives minimal reimbursement [from the County] for the treatment of medically indigent patients." Baugh added, "The bottom line is indigent care in Mobile County is being funded, and it is USA, not the county, that is funding it." (Mob.Reg., 3/19/99) The County, it appears, wants to skip out on its responsibility and the Mob.Reg. editorialist is bent on aiding and abetting that stance.

Second, the land-mine claim -- i.e., taxpayers will explode if they are saddled with a tax on alcohol to pay for indigent care. Is it really the case that Mobile taxpayers cannot understand that the USA Foundation is not an instrument of charity but a private entity responsible for investing and protecting the University's endowment funds so that those funds can be used to support the long-term mission of the university. Is it true that these same taxpayers will find it difficult to understand that indigent care in Mobile County is a responsibility of the County tax system? And is it true that the taxpayers cannot understand that the long-term success of the University of South Alabama as a site of excellence in the state of Alabama depends largely on its endowment Foundation and that that success is in their very best interest? But whether they understand or not is beside the point; there's no law which mandates that foundations must use their money for whatever indigent-care problem begs to be solved. If the USA Foundation is forced somehow to use its endowment funds that way, it can kiss excellence goodbye. The fact of the matter is that the law places the responsibility for indigent care squarely in the lap of the County. If it wants to play hardball, the university hospital system can do what the other hospitals in the County do -- treat only emergency care and turn the rest away. And waving off the problem, as County Commissioner Gary Tanner did by saying that taxes have to be authorized by the State, is just a convenient dodge.

The taxpayers are not as stupid as the Mob.Reg. would make them out to be. They know that somebody has got to pay. Medical care is not cheap and it's definitely not getting cheaper. In the April issue of the monthly magazine of the National Conference of State Legislatures, former Gov. of Colorado, Richard Lamm, has written an article titled: "Government Does Indeed, Ration Health Care." In the article Lamm contends that "We are inventing the unaffordable and spending the unsustainable. We need to focus limited resources where they buy the most health for society." Lamm offers these facts to support his contention: "the trillion- dollar annual medical bill represents one-seventh of the nation's economy"; "health care has overtaken housing as the most expensive item in the family budget"; "health care spending is growing faster than anything else in the state and federal budgets"; "the United States has by far the largest share of uninsured citizens in any advanced nation, with 43 million having no coverage now. Of the 29 industrial countries, we rank 21st in infant mortality, 17th in life expectancy for women and 21st for men." "The question," as Lamm writes, "is not if we ration -- but how. So far, we have chosen to ration by leaving one-sixth of our population uninsured and, increasingly, by trying to let medical organizations 'manage' the health care of those with insurance." (cited in David Broder's commentary, Mob.Reg.,4/7/99) In Mobile, thanks to the generosity of the USA hospital system rationing of medical care for the indigent has been minimal, but the overall situation is worsening, and the complexity of the problem goes entirely unappreciated by the Mob.Reg. The reaction of County Commissioner, Gary Tanner, is beneath contempt.

In essence, the Mob.Reg., that stalwart Republican rag, and their ally Commissioner Tanner encourage taxpayers to take the view that it's perfectly okay to pressure the USA Foundation to pay for indigent care since they're "flush with cash." If the Republicans at the Mob.Reg. are so keen on taxing the rich to pay for the poor, then why pick on only the USA Foundation? Why don't they also recommend that the many rich corporations in the County be similarly subjected to a Robin-Hood tax to pay for indigent care? Why don't they go after the banks; they have a lot of cash lying around in their vaults? Absurd? Right! But no more absurd than insisting the USA endowment should be raided to provide a temporary prop for the indigent. Why should the burden fall so heavily on the shoulders of the University of South Alabama and why try to wring the money out of the University's endowment Foundation? But should we be surprised by such self-serving proposals? Don't we all know how generous County and City fathers can be when it comes to Big Biz? Many of the corporations given handsome tax breaks by Mobile's Industrial Development Boards have been allowed to shirk their sums-in-lieu payments owed to the County School System for years and years. Who cares about welfare of County School System and who cares about welfare of the University of South Alabama? Afterall, the university is only the largest employer in the County and they have this fat endowment so let's raid it. Well, the would-be raiders of the USA Foundation are beginning to push and shove one another to get to the head of the line.

On the one hand, The Mob.Reg. objects to the USA Foundation's subsidy to Primehealth to keep it a viable component in the delivery system of health care in Mobile and surrounding counties, but on the other it thinks it right and proper for the USA Foundation to subsidize indigent care. Subsidizing indigent care through funds from the USA Foundation can do nothing for the university but bleed its endowment Foundation to death. At best, bleeding the Foundation can only be a temporary solution, whereas subsidizing Primehealth assists that organization in its efforts to remain a vital contributor to the entire health care system in this corner of the state.

What we have here in Mobile County is a Fish-Rodeo mentality. The biggest fish out there is the USA Foundation and all the greedy anglers are hungering to land that prize so they can gut it as soon as it hits the deck.

-- Tom Brennan

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