Public Health, Trust Us
Maybe It’s Time for a Little Self-Help

“There will be cuts and they will be drastic,” Nunez warns. “However you slice it, people will suffer.”

By Rebecca Wakefield

One story stuck out from the sticky spectacle of misery, greed and death in the papers last week. Not Anna Nicole. The Public Health Trust. The story, penned by Miami Herald veteran John Dorschner, revealed that our local safety net, as warped and sagging as it is, is about to lose $125 million or so from the federal government, if President Bush’s proposed healthcare cuts go through. Actually, hospitals throughout South Florida stand to lose more than $300 million.

Maybe the reason it struck me is because I, like roughly 600,000 other folks in Miami, do not have health insurance. I’m a self-employed freelance writer in good health and made the calculation that I could do without the monthly hit to my modest budget.

Lately that seems like a rather stupid risk. That means, essentially, that my primary care physician is Jackson Memorial Hospital, a prospect that scares me to the core. No disrespect to the legions who toil there, handling rolling crises in this insane town, but going to Jackson is something akin to attempting to get through the DMV, the post office on tax day, and the black hole of Calcutta at the same time. Pleasant and efficient, it ain’t.

But it’s what we’ve got. The Jackson system, which includes several hospitals and myriad community clinics, registers more than 700,000 outpatient visits, 77,000 inpatient visits, 210,000 emergency room visits and 3,700 visits to the Ryder Trauma Center. Per year. The system spends more than $530 million a year in charity care for people who can’t afford to pay. All these round numbers come courtesy of Jeanette Nunez, vice president for government relations at Jackson Health System.

Nunez’s title would indicate that it’s her job to be chipper and upbeat about all manner of traumatic events. She doesn’t even try this time. “Any sort of cut of this magnitude will have a severe and devastating impact on the hospital and the community,” she says. “It’s going to severely limit the access to care by causing hospitals to make decisions not in the best interest of the community.”

Marvin O’Quinn, the president and CEO of JHS and the Public Health Trust, seems to have done a good job stitching together a system left in near complete shambles by the previous fellow, an autocrat who had lost his way in his declining years. When O’Quinn took over Jackson Health System in 2003, it was in terrible shape, running around $85 million in the red.

A little jiggering with bond money, operational overhaul, austerity measures and cash infusions from the county now have JHS running about $28 million in the black. All that progress is in danger with the proposed cuts, which JHS plans to fight in Congress. If they lose, “There will be cuts and they will be drastic,” Nunez warns. “However you slice it, people will suffer.”

The Public Health Trust was created 34 years ago to run the growing public health system under the aegis of the county. In 1991, the public voted to fund it with a half-cent sales tax, and subsequently bond issues have been approved. It’s a roughly $1.5 billion per year operation that doesn’t really address the community’s entire spectrum of health needs, which have exploded in the past 25 years.

“Our mission is to serve who comes through the doors regardless of ability to pay and we are managing the best we can,” Nunez says. “Is it a sustainable mission in the long term? No, probably not.”

She adds that one problem is that people use JHS as their primary care facility, which is much more expensive than if they were treated at a community clinic. “We’re trying to educate people,” she says. “It’s such a mammoth task.”

On a different front of the healthcare crisis, the Human Services Coalition of Dade County is tackling the furry elephant one leg at a time. In November 2006, the coalition and its partners held the first Access through Action Healthcare Summit to attempt to put their arms around the problem. Another one will be held in April.

The first goal is to get consumers and providers talking to each other to identify specific problems that can be addressed. The second, much harder goal is to “substantially increase civic capacity, involvement and community coordination within the existing health access movements and legislative actions.” In other words, they’re trying to get people off their butts, and thinking collectively and strategically, which if they manage it, would be incredible.

Although they’ve been working on health issues for a decade, this ramping-up stage couldn’t come at a better time. Besides the Bushy squeeze on Medicare and Medicaid, we’ve got all sorts of other crises with the real estate boom and bust and its effects on property and sales taxes, which fund our state and local budgets.

Daniella Levine, Human Services Coalition’s executive director, points out that in Miami we’ve got a huge immigrant population largely employed in low-wage service industry jobs, and a small-business economy that has a hard time affording insurance for employees. Medical costs are also higher than in many other places because so many people are using the system, often inefficiently. Add to that Miami’s reputation for “a very high fraud climate,” which has been one justification for privatizing public health functions, such as dental health for children.

But managed care has often meant reduced care because a private company that is not well-monitored by the government has every incentive to keep costs to a minimum, since it usually gets a fixed fee that really covers only the most basic level of care, and only if it treats a small percentage of eligible people.

Also, there’s a huge black and gray market for health care here, which consists of everything from unlicensed doctors and dentists to prescription drugs available without prescriptions. “We have a patchwork quilt of a health safety net,” says Levine. The quilt needs greater emphasis on prevention and home-based care. “At the federal level, there is a growing awareness that our healthcare system doesn’t work.”

Today the coalition has scheduled a tour of community health programs in Little Havana and Overtown, one more step in the effort to connect street-level intelligence to the people who decide when, where and how to loosen the purse strings.

Comments? E-mail wakefield@miamisunpost.com.