The Fair-Funding Pledge 

Just as a blind squirrel will find the occasional acorn, so will the current NRA-indentured Tennessee legislature occasionally do the right thing — as when both the state Senate and the state House passed a much-needed bed tax to provide break-even funding for the Med and avert — if barely — the specter of its closing.

What makes the 3.5 percent fee on the net revenue of the state's hospitals appropriate is that it somewhat corrects the present imbalance, whereby federal dollars generated by indigent care at the Med in effect underwrite medical care at institutions, including private ones, elsewhere in Tennessee. By attracting additional federal money on a two-to-one basis, the state tax is expected to generate enough income to offset threatened cuts in TennCare funding across the board.

So far, so good, but it fails to correct the well-documented situation whereby, in the last fiscal cycle, only $34 million of the $84 million generated by Med activity was routed back to the Memphis hospital. In other words, while the new tax will help keep the Med at subsistence level and out of bankruptcy, it does not affect the existing disproportion in the way state government allocates the Medicaid dollars it gets from the feds. In a sad irony, the Med will continue to subsidize indigent care across the state, even at private institutions solvent enough to absorb such costs, as the Med itself teeters on the brink of financial collapse.

Back in February, the Shelby County Commission voted to send a letter to all active gubernatorial candidates asking them to sign a pledge that whatever federal dollars are generated by indigent care at the Med should be distributed to the Med on a one-to-one basis. So far, no candidates have complied, despite an ongoing funding crisis at the local institution that has never abated.

Commenting on the situation at Monday's meeting of the County Commission, Commissioner Mike Ritz opined: "I think what we have here is a situation where there are a lot of interests across the state that frankly are just happy seeing the Med right where it is — kind of starving, not closed, hardly open, in a facility that's about three or four times the size it needs."

Ritz further argued: "If we just had the money, for a while, to amortize the bonds on a new smaller hospital, the Med would be able to compete, to have a nice facility that would be earthquake-proof and would serve the community for another 30 to 40 years."

Whereupon the commission, in a show of nonpartisan unity, agreed that candidates for governor should be given one more opportunity to sign the fair-funding pledge. Given the political realities of those aforesaid "interests across the state" that like things just fine the way they are, the gubernatorial candidates may continue to waffle on the issue or to decline outright to sign the pledge, as one of them, Knoxville mayor Bill Haslam, was candid enough to do last week.

If they continue to hold back, that information should be, as Commissioner John Pellicciotti suggested on Monday, widely publicized at public meetings across the county.

Let the chips fall where they may.

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