Die, Poor People, Die!
The news coverage of Dallas' public hospital is always operatic. In a gleaming castle high above Stemmons Freeway, hundreds of Dr. Schweitzer clones in white coats practice noble healing arts on the poor. But the castle is under ceaseless attack from an army of right-wing Nazi meatballs screaming, "Die, poor people, die!"
The Nazi meatballs are always unfairly accusing the Drs. Schweitzer of wasting taxpayer money. All the Schweitzers want to do is "Heal, heal, we tell you!" At the end of every performance, Dr. Ron J. Anderson, president and CEO of Parkland Memorial Hospital, hurls himself from a parapet. Next morning, he's back at his desk without a scratch--a medical marvel.
I always figured it was true. It's not as if we lack for Nazi meatballs in this town. And Anderson, who has been head of Parkland for 22 years, is a forceful and eloquent champion of decent health care for the needy. I'm surprised he's not in jail.
But the caution for all of us--the suggestion that maybe there's more to Parkland than the opera--should have come at the beginning of this month when a majority of the Parkland Board of Management threw in the towel and resigned their positions, some of them publicly citing frustration with Anderson.
Let's put that in perspective. Parkland is an $850 million-a-year operation. That puts it almost in range with the Dallas Independent School District, which has a budget of about $1.1 billion. The city of Dallas is running a budget of about $1.9 billion, so Parkland is almost half as big as the city.
Hey. What would you think if a majority of the city council cleaned out their desks and went home one day because they couldn't get the city manager to listen to them? Wouldn't that be a cause for concern? I was concerned enough to call Cynthia Comparin, the board chair who resigned, to ask if I could come talk to her.
You may recall the very operatic scene that preceded her resignation--legions of the poor attempting to attend a meeting of the board at Parkland and being turned away at the castle gate. That scene was all over the TV news, where it was full of sound and fury and made absolutely no sense.
The legions of the poor were orchestrated by a couple of people I have known over the years and for whom I have great respect, the Reverend Peter Johnson and the Reverend Gerald Britt. They brought poor and working-class people to the Parkland board meeting to express worries about budget cuts at the hospital.
Comparin was stubborn and would not move her board meeting to a larger room so that the throng could be accommodated. Angry statements were made to the television cameras, pretty much accusing Comparin of being a Nazi dog. Within a week, she and her allies were gone from the board.
So that's why I called. To see if she was a Nazi dog. I was kind of hoping she would be, because that would reinforce my worldview.
Instead, when I was ushered into her office in a downtown tower, I discovered a chic young Hispanic woman, owner and CEO of a successful high-tech start-up company--really smart, thoughtful, with a generally conservative business-world outlook. She does not want the poor to die unhealed. She does think Parkland needs a more accountable manager than Anderson.
She laid out her issues plainly. The taxpayers of Dallas County provide more than one-third of Parkland's revenues through property taxes. Comparin thinks Anderson should have been more candid with voters over the years about how much of that money Parkland loses every year treating patients from other counties. According to the numbers she showed me, Parkland loses $33 million a year on patients who don't live in Dallas County.
"Collin County residents are $6 million of that $33 million," she said, "and they're the richest county in North Texas. I don't care if they're indigent, that county has a responsibility for them where they live. Why should the Dallas County taxpayers pay for them?
"And what's ironic about the thing is that the biggest absolute dollars we pay in that $33 million is for Tarrant County residents, and they have a public hospital."
Dr. Anderson has heard all of these charges a million times and has ready answers. On the particular issue of people from other counties who come to Parkland and don't pay, he said he has fought that battle from the courthouse to the statehouse steps for decades. He would like nothing more than a law forcing those other counties to pay Parkland for the bills their residents run up.
"I'm the guy who in 1982 sued several counties around and won," he said. "That led to us getting legislation passed, and then the legislation was sabotaged."
Big cities in Texas get raped on things like this because the Legislature is still rural-dominated, he said. Rural and suburban counties like Collin love getting away with sticking the big city. Anderson can't control that. The Legislature will not pass laws forcing rural and suburban counties to pay back urban counties for these losses according to any realistic or fair formula.
But here is where we finally get down to what that opera scene was all about with the throng and the wrong and the gong and the TV cameras and so on. Comparin points out that the law does not require Parkland to admit everybody for everything. Genuine emergencies, of course. But federal law states that federally supported public hospitals must provide indigent care only under a carefully drawn set of standards.
Rather than passively accept $33 million a year in losses for out-of-county patients, Comparin and her group would like to see an admissions policy with a stiffer arm, pushing some people back out the door, not admitting them to the hospital in the first place when it's clear they won't be able to pay and where barring them would be legal.
Anderson, on the other hand, not only opposes that approach to solving the hospital's problems but routinely paints it as inhumane and racist. Getting tough on out-of-county poor is in the same bag with cracking down on care for illegal immigrants--a Scrooge-like policy that would leave people dying under bridges. In a recent letter to television stations airing political ads he found offensive, Anderson said: "As a safety net hospital, there are no illegitimate patients when people are sick and in need. Whether liked or disliked, immigrants are a part of the Dallas community, and when they are sick they should have mercy."
I find that hard to argue with. I find it stirring. It's my kind of speech. But Cynthia Comparin, understandably, finds it very damn irritating to be painted as a racist, even if only by extension.
"My grandmother was an immigrant from Mexico," she said. "My father's first language was Spanish. He learned English when he went to school in San Antonio. My mother is a schoolteacher. There is nothing blue-blood about me. I happen to have had wonderful parents who gave me a great work ethic."
Pretty tough to argue with that one, too.
I asked her why she and her group quit the board. If they were the majority and believed Anderson was doing a bad job, why didn't they just fire him? She dodged the question a little but suggested clearly that they lacked the political clout to do so. And right there, I see a problem: a hired manager who has more political stroke in the city than his bosses. That seems like a wrong situation on the face of it.
The rap on Comparin and her cohort from Anderson's defenders is that they don't have medical backgrounds and know too little about the special needs and complexities of the health-care universe. I had a good conversation with Parkland board member Gary B. Wood, who owns hospitals in Latin America and reveres Ron Anderson as a "thought leader" in his field. Wood sent me his own lengthy analysis to show that Parkland operates near the top of its field.
Wood's conclusion, however, seemed to be that all the grand opera at Parkland is the fault of too much democracy. His analysis included a recommendation that seats on the hospital's Board of Management be set aside by law for special interest groups including the Dallas Citizens Council, a secret organization that dates from the pre-Civil Rights era.
Zowee. That's one bad idea!
Comparin suggests the problem is the contrary--that Parkland is too linked at the hip to the sawbones establishment for which Anderson is a standard-bearer and hero. What do doctors always want? More doctoring. What do doctors always think? Everybody else is stupid. Whose money do doctors always want to spend? Everybody else's.
So here's another way to look at Comparin. Far from being a right-wing Nazi dog, maybe she is the standard-bearer for the common old taxpayer. Maybe Anderson is the champion of an elite--in this case the white-coat elite of Schweitzer clones who believe that other people's money is no object.
Look, one bottom line here is that Anderson is a great leader for his cause and a leading citizen of the town. When he speaks, Ron Anderson deserves to be taken very seriously.
But he's also a staff guy. Those board members are his bosses. They represent you and me. It's our money. We need more public input, certainly not less.
The Citizens Council! Where did that one come from? That's just scary. We'd be better off turning Parkland over to those guys in the fezzes who ride the little miniature motorcycles in parades. And anyway, the Citizens Council can't come out during daylight hours. Or look at mirrors. What a scene that would be: board meetings in the crypt. Talk about opera.
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