Sunday, January 28, 2018

Mayor Barry ask $13.2 M more for General Hospital. Other programs must be cut to pay for it.

After proposing in November to do the fiscally responsible thing and close General Hospital and convert the facility into a out-patient clinic, Mayor Barry buckled to political pressure and reversed herself. She said she would keep its status unchanged for the remainder of this year and come up with a recommendation for the future of the hospital at the end of the year. 

Now, Mayor Barry is proposing an additional emergency appropriation of $13.2 million dollars for the facility.  This is not unexpected.  General asked for $19.7 million. The facility constantly needs an infusion of cash to operate.  If General does not get the money it cannot meet payroll.

General Hospital has long been a money pit. In the last two years the Hospital has received $26 million in emergency funding in addition to a $35 million annual subsidy from the Metro Council.  As reported in The Tennessean recently, a recent audit found that the hospital, "failed at basic bookkeeping, unable to keep track of patient payments and major expenses."

While poor management is obviously a problem, the real problem with Nashville General is that  no one wants to go there.  Metro jail inmates without insurance needing hospitalization have no choice and are sent to General and there is a financial incentive for Metro employees to use General but it still cannot fill its beds. The facility is  licensed for 150 beds, staffed for 114 and has an average of 44 beds filled a day. Metro General should have been closed fifty years ago.  Ever since the advent of Medicaid there has been no need for a city charity hospital and the reason it has been kept open is purely political. There is no federal or state law or metro charter provision requiring the city to operate a charity hospital.

Unlike past emergency appropriations to prop up General, this time the additional funding will hurt. Not much, but anytime a politician takes money away from a program it hurts.  In speaking of cuts, we are not speaking of a cut the way Washington speaks of a cut.  We are not simply talking about a reduction in the rate of growth but real cuts.

The reason other programs must be cut to fund General is because the city's saving account is running low; we are running out of money.  The city needs to maintain an amount equal to 5% of the budget in a reserve fund. That is simply sound financial management in case the city should face an emergency or in case revenue comes in at a rate less than expected.  Not only is keeping 5% in reserve a wise policy but if we do not, it will effect our bond rating and every dollar the city borrows will cost more. In the past when General needed more money we simply dipped into the reserve fund. This time, the city can dip into reserves for most of the money but must find $2.4 million elsewhere.

The city can find the $2.4 elsewhere without the public feeling the cut. No libraries or parks will close or police or fire protection will not be touched. Cuts will come from various incentive programs and other services and will hardly be noticed. Among the cuts will be $1.55 from the Housing Incentive Pilot Program and $350,000 from the storm water contingency fund and various other modest cuts.  So, we are cutting those programs no one cares about, such as affordable housing and flood control.

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