Med Matters 

Wamp's full-funding pledge impacts the governor's race and arouses state government.

A spirited discussion took place on the Shelby County Commission Monday concerning whether the body should or should not contribute $10,000 to help defray the production costs of "Message from Memphis," a We-Are-the-World-like compendium of musical offerings by Memphis-area artists. Sales of the recording and DVD, available at Walmart stores and online, will be used to raise funds for the victims of the Haiti earthquake.

The enabling resolution, objected Commissioner Mike Ritz, required that the County Commission's contribution be routed through city government, which would in turn give the money to the Memphis and Shelby County Music Commission, which would then distribute the money to the producers, described by Ritz as "people we can't give money to."

The whole process, said Ritz, amounted to "money laundering."

Commissioner Henri Brooks, a former state representative, responded that state government outlays quite often required "pass-throughs" of the sort proposed in the case of "Message from Memphis." Brooks added her own distinctive rhetorical flourish to the discussion, suggesting that colleagues who were squeamish about the grant "have got your skirts over your heads right now."

The discussion would provide something of an ironic backdrop to another discussion at the heel of Monday's commission meeting. In referring to what has to be a more decisive issue — that of adequate funding for the Med, a conundrum that has preoccupied the commission (and most of local government) all year — Ritz raised an objection of a different kind.

The background: Commission chair Joyce Avery had just announced, for the record, something all present were aware of — namely, that Chattanooga congressman Zach Wamp, a Republican candidate for governor, had last week become the only signatory to a funding pledge the commission had extended to all gubernatorial candidates.

That pledge was to return to the Med 100 percent of the federal funds received by state government as payment for uncompensated patient care rendered by the hospital. At present, those funds go into the general TennCare hopper and are apportioned out to the state's hospitals at large, with the Med receiving something like a third of what it generates.

In agreeing to sign the pledge, which he described at a "nonpolitical" press conference with commissioners last Wednesday as "the right thing to do," Wamp, who has begun employing the slogan "Memphis Matters," said the differential involved was something like $50 million — an amount that Ritz and others agree would resolve the long-lingering financial shortage at the Med, which has faced the specter of a shutdown for lack of funding.

The $50 million difference in annual funding would also be enough, all parties agree, to accomplish another long-term goal for the Med — that of amortizing the bonds to build a new, smaller, and more efficient version of the hospital.

State TennCare officials, however, have raised an objection that if a new governor should actually follow through on the full-funding pledge the amount of federal funding to the state medical system would suffer an overall drop. Though no exact formula has been adduced for the claim, the idea is that the federal monies currently received are held in a kind of escrow and, bundled up in a TennCare fund as "certified public expenditures" (CPEs), become eligible once again for federal matching funds. In other words, federal funds are used to attract more federal funds.

That's where Ritz felt compelled to object on Monday. Such a claim, which received widespread — and generally credulous — reporting in the state news media, "makes no sense," he said. And Chairman Avery dismissed the state's claim by saying, "One excuse is as good as another."

Contending that "the chairman has the flavor right," Ritz went on to outline something of a conspiracy theory, whereby the state's private hospitals, concerned about losing a portion of their federal lagniappe, and the Tennessee Hospital Association, acting on their behalf, "got excited" and responded with what amounted to a red herring.

Asked his opinion of the matter, Commissioner Steve Mulroy, a law professor at the University of Memphis, concurred with Ritz and Avery on the disingenuousness of the state's claim. Even granting that the $50 million sum in question could draw additional federal funding if bundled up with other TennCare monies, it could be paid out to the Med in full once that additional funding was received.

The aforementioned irony is that such a procedure — essentially just a modest cart-before-the-horse adjustment — would involve something of a "pass-through" process in state funding. Brooks was correct in her earlier argument with Ritz. Such accounting methods are common in state government. Q.E.D.

Meanwhile, no one, not TennCare officials and not one of the three other gubernatorial candidates — Knoxville mayor Bill Haslam and Lt. Governor Ron Ramsey of Blountville, both Republicans, or Jackson businessman Mike McWherter, a Democrat — has disputed that indigent care provided by the Med results in the Memphis institution generating a disproportionate share of federal paybacks, nor that the state's allocation to the Med from all sources combined is less than the total amount of these Med-generated funds.

In short, as virtually all local officials have maintained, regardless of party or their position in the sphere of government, the Med is being short-changed. Not even the recently enacted bed tax passed by the General Assembly would do anything to redress this perceived imbalance. Nor would the Med's hanging-by-a-thread status be much affected.

Already the other gubernatorial candidates have reacted to Wamp's bold move by proposing a variety of summits and further discussions to find some formula for the Med other than the one-to-one payback method. But both interim Shelby County mayor Joe Ford and Memphis mayor A C Wharton, as well as various other Memphis and Shelby County officials, already have been down that road. Talks with Governor Phil Bredesen and other representatives of state government have been strained at best and unproductive at worst.

Ritz admits to a cynicism about the bed tax and other proposed solutions short of the one-to-one formula, and he sees the influence behind the scenes of private hospitals as being formidable. "They don't want the Med to fail, because that would mean they'd have to take over too much indigent care themselves," said Ritz, who extended the argument to include Nashville General and Chattanooga's Erlanger, two other charity-care hospitals. "But they don't want such hospitals to get too comfortable, either, because that would make them too competitive. Starvation rations is something they'll settle for."

Whatever the realities, Wamp stands to gain politically in Shelby County, which by some estimates generates a fifth of all Republican primary votes. Last Wednesday's press conference, which was attended by Democratic commissioners Sidney Chism and Mulroy as well as several Republicans, was deemed nonpolitical, as mentioned, but there were brief conversations among some of the GOP commissioners about endorsing Wamp as a body.

That idea seemed to have been scotched at Monday's commission meeting — Avery announcing that "at this time" she would not be seeking or advising such a formal declaration, but no one disputes that Wamp has gained significant political collateral in Memphis and Shelby County.

If nothing else, he has made a decisive response to the widespread suspicion, whether justified or not, that Memphis and Shelby County are orphans to state government and don't get either the funding or the respect that other regions do. (In particular, Bredesen's several remonstrations to local officials to get the Med's house in order before seeking more funding has been a source of local discontent.)

"Memphis Matters" is a slogan lately adopted by candidate Wamp. One way or another, his gubernatorial rivals will henceforth be challenged — by thought, deed, or concrete proposal — to match it.

The Republicans among them would quickly have their chance. At press time on Tuesday, Wamp and the other GOP candidates were preparing for a televised Tuesday-night debate on WKNO-TV, sponsored by the Tennessee Public Television Council and the League of Women Voters of Memphis and Shelby County.

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