Governance change not the last vote on UMC

The Clark County Commission's vote Tuesday will not be the vote that saves University Medical Center.

No, that vote - to ensure there's enough money to take care of everybody who needs health care in Las Vegas, regardless of whether they can afford it - is yet to come.

Instead, Tuesday's vote simply seeks a new state law that allows the region's only public hospital to change the way it's governed. If the Legislature cooperates (still an open question, given the tendency of Carson City to micromanage local governments), a new "county subsidiary corporation for health care system" will be born. Instead of county commissioners directly supervising the hospital, a board of directors will give it full-time attention.

The hospital will still get subsidies from the county, its books will still be open to public inspection and most of its meetings will still be public. But it will be allowed to hold closed sessions to talk about business strategy and withhold documents that contain proprietary information.

According to the county, contracts with labor unions will continue uninterrupted, and employees will retain their seniority and their accumulated leave time. Count members of the Service Employees International Union as skeptics, however: Several spoke out against the change.

And the vote on the commission wasn't unanimous, either: A liberal bloc of Commissioners Tom Collins, Chris Giunchigliani and Lawrence Weekly voted no, and they gave some good reasons against a change.

Collins said giving up direct oversight was shirking responsibility. "Giving that responsibility away is not what we're hired and elected to do," he said.

Giunchigliani said how the hospital is managed isn't the real problem, and she marveled at the effort that had gone into drafting the proposed change.

"I'm not sure what the whole purpose of this is," she said. "In government, you have to answer the question of why you're doing what you're doing."

What are the real issues, then?

First and foremost, there's funding. UMC operates at a loss, because it treats people who are uninsured and can't get care anywhere else. But that's a good thing: In America, we're not supposed to let people die because they don't have any money. If county bureaucracy has a heart and soul, it's located on Charleston Boulevard, in the ER at UMC. And it's animated by the hundreds of dedicated professionals who work there. (I should know; I've been a patient at UMC as well as at a private hospital in the valley. And while I got good, professional care at both, the UMC experience was of a much higher caliber, mostly because of the staff.)

And yes, let's acknowledge that some of those costs are caused by illegal immigrants seeking care at UMC. This, too, is a good thing. In America, we're also not supposed to let people die because of where they come from, or because they broke a law when they crossed a border. And lest we forget, it was President Ronald Reagan who signed the law that said hospitals must treat all people - regardless of wealth, national origin or any other factor - in emergency situations.

So the effort up until now has been to reduce the size of the deficit, a task that UMC has been steadily working at for years. It's going to get harder, however: Under the Patient Protection and Affordable Care Act, subsidies to so-called safety net hospitals such as UMC will drop, because the law provides health insurance to millions more people. But UMC CEO Brian Brannman says the drop in funding won't be offset by the influx of new, paying patients. He estimates that the deficit from 2014 to 2019 will be about $53 million.

That brings us back to Giunchigliani: "We have an obligation to fund this hospital. If this forces us to do what we're already allowed to do by law [raise property taxes], we should step up and do it," she said.

Other commissioners - including Steve Sisolak - disagreed. He said the size of the property tax increase would be too large, and the county owes it to the community to try everything else first.

He's not entirely wrong; allowing UMC to explore new business opportunities, get more paying patients and seek grants and donations it doesn't get now are all good ideas. Perhaps the change approved by the commission on Tuesday will be a step in that direction.

But at the end of the day, the county has an obligation - legal, as well as moral - to make sure UMC is funded sufficiently to care for the people of Clark County, especially those who can't afford health care otherwise.

That vote didn't take place Tuesday. But it will come, perhaps soon. Let's hope when it does we demand the county act to save UMC.

Steve Sebelius is a Review-Journal political columnist and author of the blog SlashPolitics.com. Follow him on Twitter (@SteveSebelius) or reach him at (702) 387-5276 or ssebelius@reviewjournal.com.