Pick a health catastrophe, any health catastrophe, and it perfectly illustrates the myriad fiscal woes of Clark County government and its biggest budgetary ailment, University Medical Center.
Recession-induced cardiac arrest. Massive hemorrhaging from runaway growth in personnel costs. The blunt-force trauma of providing millions of dollars in uncompensated health care to illegal immigrants.
Clark County is facing an estimated $120 million revenue shortfall next fiscal year; layoffs will begin in about two weeks. UMC, on its own, lost about $83 million last fiscal year, with more huge losses projected this year. It's going to take extraordinary measures to save these patients.
How extraordinary? How about the possibility of county government severing the IV that ties taxpayers to the region's only public hospital?
On Wednesday, the County Commission, meeting as UMC's Board of Trustees, discussed the possibility of privatizing the hospital. Commissioners heard a brief presentation from Jim Miller, the president and chief executive officer of Reno's Renown Health System. Renown was a public hospital until Washoe County commissioners handed it over to the private sector as a nonprofit in 1985.
In a brief question-and-answer session with commissioners, Mr. Miller laid out the years of deliberations and work that went into the Reno hospital's transition from unsustainable tax consumer to thriving nonprofit.
The Legislature had to authorize the switch. Public debt had to be refinanced by private-sector investors. Employees and vendors had to have their contracts amended. A citizens group was established to select a board of directors.
Mr. Miller said that while the hospital gets a very limited amount of funding from Washoe County for indigent care, the operation otherwise gets by on revenues and donations. It has expanded over the years to meet the community's needs, including a pregnancy center for women who might otherwise go without prenatal care, and it doesn't turn away the uninsured. Washoe County taxpayers are off the hook if Renown's finances ever run into the red.
That had to be sweet music to the ears of some commissioners, who have grown weary of throwing ever greater sums of money at UMC at the expense of other services. In 2007, a taxpayer bailout of the hospital cost $60 million. This year, the Review-Journal highlighted how 80 uninsured illegal immigrants with failing kidneys receive about $2 million worth of dialysis treatments every month. The taxpayers who cover those bills, meanwhile, have longer and longer waits in the emergency room.
UMC provides invaluable services to the valley, its trauma center and burn unit foremost among them. But the politics of the commission -- subservience to unions, a lack of will to address the burden of illegals, shoddy oversight -- has put the entire operation on the brink of collapse.
A study of the merits of privatization is long overdue. The County Commission has tough choices ahead. It must make them before UMC bleeds the taxpaying public dry.