Parkland's Future CEO Can't Heal Hospital Without Support Missing from Austin and D.C.

Warren Fagadau, a Dallas ophthalmologist who has been involved in health insurance reform efforts in Texas, has a piece on the op-ed page of The Dallas Morning News today about the qualities our public hospital in Dallas should look for in its ongoing search for a new chief executive officer. His views are measured, well-informed and reasonable, so I thought maybe this was an instance where I might help balance things out by offering the other kind.

In the end, none of what is really wrong at Parkland will be solved at Parkland. Even in the chaos that is Texas politics, we have to look for the wave, and the wave is this: Texas shirks its responsibility to provide healthcare for the indigent and working poor at the state level but leaves that obligation open at the local level. And that happens because the advocates of denial are afraid to state the necessary implication of their beliefs.

The thing our new Senator Ted Cruz lacks the balls to say -- but clearly means - is that he thinks we need to slam the doors shut at Parkland and just let people die in the streets. That is what he wants. That is what his supporters in the Tea Party want. But they won't say it.

The future of public health care under Tea Party leadership.
Fagadau in his essay today offers several suggestions for the kind of research-based collaborative leadership we need on the issue of public health and care for the uninsured at Parkland. Given his past involvement with the Texas Health Institute, a nonprofit that argues for health insurance reform, it's obvious that Fagadau knows this ground well. But I wonder if he's too focused on the ground.

The bigger picture is this: We don't just let people who don't have insurance die in Texas. We pay for their care locally, here in Dallas at Parkland, largely through the property tax and subsidies padded into private insurance premiums. We don't want to just let them die because they don't have money.

But Cruz does. That's not my idea. I didn't dream that up. That's what the state's largest association of doctors said last July when Cruz said letting poor people go to public hospital emergency rooms was a better cheaper solution than expanding Medicaid. Arlo Weltge, a Houston emergency room doctor who is chairman of the Texas Medical Association's political action committee, told Bob Garrett of the Morning News that Cruz was dead wrong about cost. Then he said, "If it's the cheapest solution you're after, Mr. Cruz, why don't you just let the poor people die in the streets?"

Hospitals like Parkland are screwed because the Tea Party people and their new regent, Senator Cruz, lack the moral courage and the integrity to follow their own dicta through to the inescapable conclusion and consequence. They want people who can't afford private insurance to die in the streets. They won't say it out loud. I don't know: Maybe they even lack the courage required to say it to themselves. The position they take instead is a gutless kicking of the moral can.

They won't pay for it at the state level, where the law of the land says the responsibility is supposed to abide. Texas, in fact, is one of the worst places in America for healthcare for the working poor, a fact the rest of the country glimpsed during Governor Rick Perry's National Oops Crusade in 2011: Fully 26 percent of Texans that year were uninsured compared to the national average of 17 percent.

Parkland has its own problems. I detract absolutely nothing from the brilliant reporting the News has done on problems at Parkland over the last few years. But one can't help noticing that almost all of the problems have involved some failure to deal adequately with the sheer crush of indigent patients coming into the emergency room. So we have to wonder how much of the ultimate solution is even in the purview of Parkland itself and how much of it must occur in Austin.

What Perry has done at the state level and Cruz will now try to replicate in Washington is a gutless shirking of that responsibility. They deny it is the state or federal government's responsibility to help make insurance available to the non-affluent. But they lack the fiber required to follow their own position through to its logical implication -- go die in the streets. And so they kick the can straight to the door of the ER at places like Parkland, creating fog-of-war conditions where terrible mistakes are made.

There's a kind of face-hiding hand-over-mouth giggle in the way Cruz and his followers handle the issue. "It's not our job to help them stay alive. But if you've got a lot of extra money at the local level, well then ... be our guests." I wonder which is more despicable -- the impulse to let people die or the refusal to own up to it? I guess if you are one of those people, maybe it's not an interesting distinction to make.

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