Attempting to restore both morale and fiscal sanity to a county hospital whose previous gang of imported Chicago operators face indictments for misappropriation of funds — a public hospital still hemorrhaging cash and thus requiring taxpayer subsidies at unacceptable levels — new (local) CEO Kathy Silver and her management team had some tough cost-cutting decisions to make, late last year.
They made those tough calls. One of them was to close the hospital’s outpatient oncology unit, which was projected to show an ongoing loss of $3.5 million per year. The unit was targeted for closure in part because those services are available elsewhere in the valley.
The announcement of the closure was not buried in a footnote on some obscure bulletin board. Ms. Silver and her team — including county financial officers — took a deep breath and did the rounds to explain their rationale, and the tough choices they faced. They visited the Review-Journal’s editorial board, among others. There were prominent news stories. So far as anyone can recall, in all the intervening months, no state legislator raised a peep.
Then, last week, the CBS magazine show "60 Minutes" featured Las Vegas oncology patients complaining about the closure of the program.
Cancer patients seeking oncology treatment make sympathetic subjects. Little emphasis was given to the fact the treatment is available elsewhere in the valley — that the real problem for most of these patients involve finances. Once again, the unstated subtext is that happy nonsense that insists everyone should get everything they "need," for free if they can’t afford it.
There was certainly no detailed explanation in the "60 Minutes" sob story of just how much worse off a vastly larger number of southern Nevadans would be, should University Medical Center go bankrupt and close.
Suddenly, goosed by the TV coverage, the state Legislature swung into action. Last week, racing a Friday deadline, the Assembly Health and Human Services Committee in Carson City approved Assembly Bill 433, which order UMC to reopen its outpatient cancer center and treat indigent patients from Clark County, essentially for free.
To do so will cost the hospital an additional $3.5 million per year in non-reimbursed losses, hospital staff testified.
Despite this, the committee backed the bill without specifying any source for the funds.
Now, UMC is a public hospital. It does lots of things at a loss. To date, taxpayers have covered those losses, willingly for the most part, out of compassion for their fellow men. But the medical supply companies don’t deliver supplies for free. Nurses enjoy receiving that occasional paycheck. Electric bills still have to be paid. And the ability of Nevadans to foot ever higher tax bills is sharply limited a) due to the current recession, and b) unless we want to become the kind of tax-the-air-they-breathe state that Americans are currently fleeing in droves.
Besides, once the Legislature undertakes to wave its magic wand and require any Nevadans to give stuff away for free because it makes the legislators feel good, why should we believe they’ll stop here?
Why not simply order every Nevada doctor to treat every patient "in need" for free? (It still sounds like a joke, but the federals are actually pretty close.) Why not simply order every Nevada restaurant to provide unlimited free meals to the homeless? After all, food is "a necessity" and starvation is a nasty way to go. Nah, don’t worry about how to pay the bill — restaurant owners are just greedy capitalist millionaires who deserve to be taxed more heavily, anyway — Barack Obama’s electoral majority tells us so.
It’s easy to feel sympathy for sick people who can’t afford some of our wonderful new — and expensive — forms of medical care. But do we want more sick people who can’t pay their bills, or more people who CAN pay their bills?
Yes, leaving aside a few folks too severely handicapped to earn their way in the world (and that’s what voluntary private charities are for), the question is really that simple. By our choices in what we reward and what we punish, we will always get more of what we reward, and less of what we punish.
What we should be doing is rewarding those who work hard, play by the rules, get a good job, save for the future, and can thus afford to buy health insurance — or simply pay cash. They are "rewarded" when we let them keep enough of their savings to take care of themselves and their families in a future time of need.
We should NOT be rewarding the counterproductive behaviors of those who decline to apply themselves to learning valuable job skills, who do not save and invest for the future, who place themselves in a position where they either cannot afford health insurance or decide to spend the money on good times, instead.
Yet when we seize bread from the mouths of the productive to pay for the care of those who can’t afford or can’t be bothered to care for themselves, we PUNISH the very behaviors we should be rewarding — those delayed-gratification, "play-by-the-rules" behaviors which leave taxpayers with enough wealth to tempt the looters in the capital — while REWARDING the behaviors of those who say "Work? Save? Give up gambling and my favorite intoxicants to pay insurance premiums? Ha! If I ever get sick somebody else will pay for it."
Thus do we breed more "needy sick people." While anyone who objects is accused of "having no sympathy for the sick and the needy"!
HOW ABOUT FREE HOTEL ROOMS? WE’VE GOT A LOT OF THOSE
And so we will see more of those mendicant behaviors — since after all, what do they have to lose? — until the taxpayers are as broke as their beneficiaries.
A Legislature that can order UMC to give away $3.5 million per year can order any of us to give away anything we have — including the spare bedroom and the leftovers in the fridge — to those "in greater need." The Bolsheviks tried this in Russia in 1917. By 1921, any Russians who hadn’t fled to the West were broke and starving — the people boiling their shoes for "soup." Comrade Lenin ordered Comrade Trotsky to quietly shoot the most radical of the Marxist factory managers, whereupon he brought back the Czarist bureaucrats to see if they could restore some order.
Communism didn’t last a "glorious," homicidal 74 years. It failed in four. The rest was just seven decades of killing people to make them keep their mouths shut.
But in Carson City, they’re willing to try it all again. After all, that kind of thing "can’t happen here." This is America! We’re all rich!