Commission, it's time to yield the helm of the SS Jackson
By Michael Lewis
In a bathtub toy navy, even a sinking hospital ship is better than no ship.
That's why Miami-Dade commissioners are dragging their feet on the path to rescue Jackson Health System. They know any real solution will tug their toy away from them.
The public hospital system that commissioners control is sinking in a sea of red ink. Much of the blame falls on commission admirals who push the leaky system around as a toy, just like their toy seaport and airport.
Because the crew of the SS Jackson Memorial is top-heavy with voting union members, commissioners have long clung to padded payrolls, handicapping Jackson despite its top-level medical care.
Then commissioners last week voted to clap their new Financial Recovery Board overseeing Jackson in irons when labor contracts come into view. The commission, they said, stays at the giveaway wheel.
So even as report after report details cash draining out of Jackson and experts log the days remaining before it can no longer meet payroll, commissioners paddle against the current dilemma: yield the helm or go down with the ship.
Commissioners long shielded themselves from Jackson's financial failings by deflecting blame to the Public Health Trust they wouldn't let do its job unfettered. Now commissioners have substituted the recovery board for the trust but keep putting in their own oar and pulling in another direction.
Commissioners also are training their guns on the report of another of their creations, the 20-member Hospital Governance Taskforce that was floated to tell them how Jackson should be commanded.
Their own taskforce experts, in virtual mutiny, recommended that commissioners yield much of their dominance to a new implementation team that's to find a way to convert Jackson to a nonprofit totally free of commission control.
You don't have to imagine how commissioners view mutiny. They'd make the taskforce walk the plank — if Jackson could afford a plank.
Instead, they plan to deep six the recommendations via the oldest of tortures: study the plan to death.
"I want to put the questions to the people... in public meetings, so they can actually tell us what they feel," Commissioner Jose "Pepe" Diaz said two weeks ago. "We need to hear from everyone."
Yes, after months of hearings and studies, with experts flown here to tell the governance taskforce how problems faced by hospitals like Jackson nationwide are being met, Commissioner Diaz plans to enlist each and every citizen of Miami-Dade to explain what should really happen.
And that is what the commission's Public Safety & Healthcare Administration Committee — the commissioners who personally push Jackson around their bathtub — decided to do.
Incredibly, commissioners took the course Mr. Diaz charted to hold a hearing in each of their 13 districts over the next two months. After that, all 13 get to chew over the results and decide what they want to do — like, scuttle the careful work of experts and do whatever the heck they wanted to do in the first place, if anything.
You could have predicted this. In fact, commission Chairman Joe Martinez did.
As Rebeca Sosa worked in December to get fellow commissioners to launch the governance taskforce, he warned that it could yield to "paralysis by analysis," a ploy to substitute studies for any real action.
"Change, if it's a good change, is very positive," Mr. Martinez said, "but we're all resistant to change sometimes."
If change diminishes commission power, "sometimes" becomes every time.
Before the commission put the Public Health Trust in the brig, then-commission Chairman Dennis Moss made clear that he'd surrender control of Jackson only at sword-point:
"As the commission, we formed the Public Health Trust," he said. "The commission should be the ones directing and driving that.... Governance should remain with the board."
Unfortunately, it was the commission's landlubber steering that helped send the SS Jackson Memorial onto the rocky shoals where it's foundering. New hospital skipper Carlos Migoya is urging private partnerships as lifeboats. So is the governance taskforce.
It's time for the commission to let someone else play with their toy boat, someone with expertise and profit motives. Yield the wheel to professionals.
Jackson is one case where "Don't give up the ship" is a bad order. Don't bother holding 13 hearings to learn what everyone already knows: county commissioners make rotten admirals.
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