By Suzanne Sprague, KERA 90.1 Reporter
Dallas, TX – Suzanne Sprague, KERA 90.1 Reporter: Parkland's budget crisis began last year when it got hit with declining state and federal revenues. County commissioners had to raise taxes 10% to fund the hospital, but even then, administrators needed $30 million of Parkland's reserve funds to keep it operating. So the hospital began putting pressure on physicians to keep costs down. Susan Briner is a pediatrician at one of Parkland's seven community clinics.
Dr. Susan Briner, deHaro-Saldivar Health Center: For instance, the physicians are now encouraged to instruct patients about the responsibilities for paying for drugs. Before, we never thought about that. But that's one place Parkland is trying to not lose so much money is with medications, so that when people go to the pharmacy, people are asked to pay, based upon their ability.
Sprague: Parkland has made other significant changes as well. It will cut 200 staff positions and $58 million in spending this next year. But County Judge Lee Jackson says the proposed 31% tax increase won't replace all of Parkland's reserve funds.
Dallas County Judge Lee Jackson: They would like to restore that $30 million dollars that they spent last year all at once. We may only approve $8- or $10 million dollars this year, and it may take you three years to replenish the $30 million dollars in reserves.
Sprague: Jackson says Parkland may also have to delay some major capital projects it had budgeted, such as a new ambulatory surgery center. But as commissioners continue to study Parkland's budget, they may make further cuts, which could slightly lower the 31% tax increase. Parkland officials say they can live with the proposal currently on the table, but any other cuts may endanger the hospital's operations. Ron Anderson is the president and CEO of Parkland.
Dr. Ron Anderson, President and Chief Executive Officer of Parkland Health and Hospital System: When we talk about public health, many times people get that confused with the care of indigent people or uninsured people. I look at public health as the care of all of us. So I think if we don't fund Parkland appropriately, all we're doing is shifting the responsibility to the private sector, and they're not in a position to handle it right now.
Britt Barrett, President and Chief Executive Offier, Medical City Dallas Hospital: Dr. Anderson is absolutely right.
Sprague: Britt Barrett is the president and CEO of Medical City Dallas Hospital.
Barrett: It would be a health care disaster that we would all have to deal with. If Parkland was to eliminate those primary care facilities, every hospital in this community would see an increase in patients that are much sicker flooding into the emergency room. That emergency room would be full of earaches, sore throats and the flu, and the length of time to respond to a true emergency, like a heart attack, would increase.
Sprague: But not everyone agrees Dallas taxpayers should bear the burden of this dilemma. Jim Jackson was the only commissioner who voted against a tax hike Tuesday. He says Parkland hospital needs to be run more like a business whose primary concern is the bottom line.
Dallas County Commissioner Jim Jackson: I would bring in a professional hospital administrator, preferably outsource it and privatize the management of Parkland. I would change the qualifications for taxpayer-assisted care to make it more restrictive.
Sprague: And everything Parkland does outside of caring for the county's poorest residents would be on the table.
Jackson: Every service. Every employee. Whether it be the PR department, whether it be the injury prevention center. So yes, I am bottom-line, and that's the real world. And only government bureaucrats can think about Fairyland without looking at the bottom line.
Sprague: It was the bottom line that forced eight public hospitals in Texas to close last year and spurred the Clinton administration to authorize a $1 billion bailout of the L.A. County hospital system earlier this year. Health care experts offer a wide variety of other solutions for the country's public health care crisis, and some believe the answers lie with federal reforms. John Goodman is the president of the National Center for Policy Analysis, a conservative think-tank in Dallas. He believes the federal government's role should be to increase access to health insurance.
John Goodman, President, National Center for Policy Analysis: At the federal level, we need to give tax relief to those people who buy their own insurance. And the government should be just as generous to people who purchase their own as people who get it through an employer. Additionally, we need to have a way to use the safety net money that we're now spending on the uninsured to help people buy into employer programs or buy their own insurance directly.
Sprague: There are costs to that plan. Hospitals like Parkland could end up with fewer charity cases, but also less overall revenue because the newly insured may be required to go to private hospitals. Advocates for the poor would rather see the state of Texas re-examine how it administers Medicaid. If this publicly-funded insurance program for the poor were easier to access, Parkland Hospital could get more money. Right now in Texas, a family applying for Medicaid has to fill out a 14-page form documenting all of their assets and then go to an interview, according to Anne Dunkelberg with the Center for Public Policy Priorities in Austin.
Anne Dunkelberg, Senior Policy Analyst, Center for Public Policy Priorities: And that interview can take, depending on where you live in the state, it could take as little as an hour and a half to amounting to spending an entire day and a half at the DHS office. Perhaps the biggest problem is just that it's so complicated to document all of those assets that a lot of families just give up.
Sprague: But there's a trade-off here, too. If Medicaid were easier to access, the state would have to come up with more money to pay for it. All of these solutions put some burden on taxpayers. So some physicians, like Gus Krucke at John Peter Smith Hospital in Fort Worth, believe the public is faced with a more fundamental question than which state or federal policies to change.
Dr. Gus Krucke, John Peter Smith Hospital: The community, the society needs to make a decision about what is important to itself; and if it is important that human beings deserve some basic level of health care, then we should then go about to taking down barriers to intelligent discussion regarding the proper path to achieve that goal.
Sprague: Dr. Krucke says that means the public has to decide where it wants to draw the line. Does it want to pay for a kidney transplant for an 85 year-old diabetic? Does it want to immunize low-income children? Does it want to fund a class that teaches people to stop smoking? These are the really tough questions. But Dr. Krucke believes it's the most honest way to approach community care.
Krucke: Therefore, there is no covert rationing of health care. It's above board. Everybody in the community has a chance to contribute to that conversation, not just physicians, not just health care administrators.
Sprague: Dallas County Judge Lee Jackson says commissioners are not holding this kind of conversation. He believes that's a question best left to higher-level policy-makers. But Commissioner John Wiley Price says the days of free care for all at Parkland Hospital are over. So the county and hospital administrators will have to reinvent how Parkland fulfills its mission if it wants to survive in the 21st century. The public will have a chance to comment on the Parkland budget during a hearing September 5th. A final vote will take place a week later. For KERA 90.1, I'm Suzanne Sprague.