Never has that old saw been so relevant as it is to the ongoing effort to save the Regional Medical Center at Memphis from financial collapse. Despite vigorous efforts by Med administrators and Shelby County legislators from both parties to shore up state aid for the beleaguered institution, the cost-cutting administration of Governor Phil Bredesen has not yet signed off on any of several different rescue plans for the facility.
The bottom line is this: The Med generates for the state an estimated $50 million in federal funds as a direct and quantifiable result of the amount of uncompensated care it provides in a region where income levels are disproportionately low and insurance compensation is often nonexistent. Only a fraction of that federal money is rerouted by the state to The Med, however, with most of it going to other "safety-net" hospitals throughout Tennessee. The Med has been seeking half the amount it accounts for, or $25 million, had won promises from the previous administration of Governor Don Sundquist for roughly half of that amount, or $12 million, and has seen the current administration cut that figure by another half, meting out so far only a grudging $6 million and sending signals which some observers have interpreted as meaning The Med could be destined for ultimate shutdown at some point during the state's continuing fiscal crisis.
The rationale for the administration's point of view is that it is committed to across-the-board cuts in the state budget and that a deviation from that policy serious enough to do The Med any real good would upset the state's fiscal apple cart -- one that is in a tenuous and delicate state of balance -- and encourage political reprisals elsewhere on the ledger sheet.
As the Flyer's Janel Davis documents in this issue, The Med provides medical services for the indigent that no one else can and, while its own fiscal viability has been seriously undermined by the paring of insurees from TennCare rolls, it still renders an ironic service to the state-run insurance program. As Med chief administrator Bruce Steinhauer says, "TennCare can no longer think of The Med as something to bail it out. It costs us more to provide TennCare services than we are paid by TennCare, so in any sense of the word TennCare is using us to bail them out."
Moreover, any serious reduction in the ability of The Med to provide medical services for the indigent and uninsured will result in larger burdens being placed on other institutions in the region -- a factor that will drive medical-care costs sky-high.
Even Haley Barbour, the conservative Republican running for governor of Mississippi and otherwise a government-basher and downsizer in the Bush mold, has made the case for The Med. (Indeed, it was his quite proper effort to do so in a campaign visit to suburban Memphis that became the occasion for his now infamous "whorehouse" slip when he ad-libbed remarks about the adverse effect of childhood education without Head Start.) Mississippians, Barbour said, shouldn't be "freeloaders," and the Magnolia State should contribute its "fair share" of upkeep for the indispensable facility across the state line.
Tennessee, and especially its Democratic governor, Phil Bredesen, could surely be at least as solicitous about doing what it takes to keep The Med in operation. Otherwise, the expense to Tennesseans of increased medical costs, in both public and private institutions, will far offset any short-term gains in state budgeting.