Nick's Blog

Jinati

The Serbian word inat is virtually untranslatable.  It is a word that depicts a special state of mind, a kind of argumentative defiance combined with infantile obstinacy, a concept that Serbs claim to be their monopoly.  Having said that, however, the Greek word, Jinati means exactly the same thing.  Consequently, I don't believe that either country has the corner on this type of thinking.

As we observe the current argument over the status of the taxation base in urban areas, we are curious about "why things have to be the way that they are."   

When you are a non profit organization the size of the University of Pittsburgh, it may be an arguable point that the University's police force is as highly trained and competent as that of the near bankrupt City of Pittsburgh. Hence, why would you even consider supporting the City's efforts? 

Hmmmmmmmmm?  Logic like that could put a State like Rhode Island in a jam if they allowed themselves to become dependent upon their own air force or army.  I'm sure the Rhode Island National Guard is a good bunch of soldiers, but would they really want to take on the Vikings, or Russia...or even the Nantucket Navy? 

So, what of Johnstown, or Windber or Somerset?   Do we, as not for profit organizations have any obligation to support our cities?  In our case the Windbercare payrolls are over $21 M annually.  Surely some of that money goes into the Borough coffers.   We pay for building permits, there are local taxes on our employees as well and, when you look at the overall $50+ M contribution that the budget makes to this area, one must assume that there is benefit inured to the taxing entities.

What happens, however, if the fire department goes out of business in either?  Could an all volunteer fire department in Johnstown really handle a Laureview type fire in one of the buildings down there?  What would life be like in Windber if the closest fire departments were miles away?

It seems to me that the jinati attitude regarding these matters needs additional exploration as the have nots continue to fight with the have nots.  Be it Windber, Pittsburgh, Johnstown or Eighty four, Pennsylvania, our cities and boroughs are in a bind, but so too are our hospitals.  We, at Windber Medical Center, as do our counterparts in other areas, pay an in lieu of taxes amount to assist our County, Borough and School District , but is that the correct answer? 

If we have 34 runs to the hospital from the fire department each year, is that rightfully paid for by everyone?  Should those costs be spread around?  Should the donations be based upon square footage covered?  Or is it just "their problem" to make it all work? 

On the other hand, is this all a slight of hand as elected officials run for re-election on claims of not raising taxes while fees continue to escalate through your medical bills?  I'm not sure of the answer, but the question keeps getting bigger and bigger as more and more urban space is consumed by the not for profits. 

In California, a new tax was proposed on hospitals to ensure health coverage for all people living in that State.  Who pays that tax?  I'm sure that, in some way, it will appear on every bill for every patient who crosses the hospital's threshold.   

A counter question might be, who is going to pay for every uninsured individual who crosses our threshold?  Should the City, the State, the Nation?  This is another conundrum because right now, no one is covering the 47 M uninsured, and we are still taking them in our Emergency Rooms with open arms.

So, where are the negotiators when it's time for compromise?  Why must the answer be: "If you don't give us money, you do not deserve to continue to hold your not for profit status."  What does the non profit mission have to do with political deficits? 

As a supporter, through the provision of hospital funds, of dozens of other not for profit organizations, how much is enough?   Is it important to support our festivals and our performing and visual arts organizations?  What if every dime that is currently utilized to fund all of the activities that improve the quality of our lives in this area was diverted to fire and police protection?  Would there be anyone left to protect? 

It is clear that these are complex issues, and that resolution is not going to be easy, but something else is also clear, an inati attitude is not going to make it go away.  Fighting over who has less fish to eat is not going to feed the family . . . we need to teach someone how to fish!

Sorry, wish I had better answers.  Comments will be embraced and published.

Glamorous?

Glamorous?  Yep, that's how some people see my life, glamorous.  Heck, I've been to Bosnia, Nigeria and now, Serbia.  The day started at 5:00 AM as I walked up to the ticket counter for my 6:45 flight.  It was a short hop to New York, but this particular day would be very long.  Typical trans-continental flights leave at around seven or so at night and land at about seven or so in the morning.  Six or more hours magically disappear as you fly into the future. During that flight it is not unusual to be waited on a half dozen times with food and beverages, that fact alone keeps even those with sleep eye masks and ear plugs from sleeping for more than a few hours at a time.

Upon landing, a greeting party consisting of the physician in charge of the conference and a representative from the hotel met us at the exit door from the airplane's walkway, they escorted us through Passport security and took us to the hotel where they informed us that lunch will be served in 20 minutes.  Following lunch, we had about 20 more minutes before my presentation and then the opening ceremonies.  Approximately 900 physicians were in attendance at this three and a half day event.  Present at the opening were the His Royal Highness, Alexander, Prince of Serbia, the Minister of Health, the general in charge of military medicine and numerous other dignitaries and prominent physicians.

The following day was filled with lectures and workshops, but we were on a mission to visit a rehabilitation hospital and spa.  It was a three and a half hour trip each way, but our driver had amazing driving skills, and we made in two and a half hours each way without being arrested or killed. (Other drivers that we had over the three days were arrested twice for speeding and one had an accident and parked the car on a streetcar track.) The visit to the spa was amazing, the physicians were amazing, and the concept was amazing, one level beyond Windber's current span of modalities.

We returned to the hotel in time to jump in another car and meet personally with HRH Alexander, the Crown Prince of Serbia, a friendly man who was born and raised in England and the United States.  His great grandmother was one of the Queens of England.  His wife was a Greek Princess and immediately began to talk to us about her knowledge of Johnstown and her visits to Pittsburgh to assist in encouraging U.S. Steel in their successful efforts to purchase a plant in Belgrade.

The next morning we met with the Minister of Health in a private meeting, spent time at the conference and toured Belgrade.  Later that afternoon we returned for the major dinner of the conference.  It was during that event that we experienced a truly amazing celebration of Serbian heritage.  There was an ox, sheep, and pig roast (not a good day to be a vegetarian); the country's winning ethnic, brass band and presentations and awards for everyone, including yours truly.

At 8:30 AM the following morning we had a private meeting with the general in charge of military medicine at the country's version of Walter Reed Army Medical Center, a one thousand bed hospital that specialized in every aspect of care including transplant surgery.

We returned to the city for lunch, went back to our rooms to pack, had a quiet dinner and left for the airport at approximately 11:30 PM Wednesday evening, 5:30 AM Belgrade time.  For the next 24 hours we were in transit from Belgrade to Paris, Paris to NYC, New York to Pittsburgh and then drove from Pittsburgh to home.  Truthfully, it was a nice break. WindberCare pins are now firmly planted on lapels throughout the Balkans, and only time will tell what the future will bring. We met with several medical students who are interested in doing research with us, several physicians who have vowed to visit us from as far away as Korea and as near as the Cleveland Clinic and have made new friends from Bosnia, Slovenia, Russia, Greece, Italy, France, England, and Montenegro, to name a few.

Our work continues to be heard, discovered and embraced internationally, and our desire to make Windber an international center of excellence continues to move forward.  It once again reinforces the fact that we really are all one world and that a child in Serbia has the same hopes and dreams as a child anywhere.  So do his parents.

To Belgrade

It's about 11:30 AM on Saturday, 10/12/07, and I'm on my way to Kennedy.  That's JFK Airport in New York City.  This will be a very long day as I wait until 7:00 PM for a connecting flight to Paris, and then run for 45 minutes through that airport to make my next fight to Belgrade. Once in Serbia, we will deplane and almost immediately make a speech to the participants of the World Health Congress on Cardiology.

I'm not exactly sure what we will be finding there, but, not unlike my trips to Nigeria and Bosnia, the one thing that I am sure that I will find will be wonderful, friendly people.  In fact, my brother, Charlie and a Serbian-born friend, Steve, will be there with me.

We will be meeting with the Minister of Health, the Head of Military Medicine and a Health Spa.  Then we will head home on Thursday.  It will be lots and lots of travel, lots and lots of talking, and not much sleep, but next weekend will give me plenty of time for that.

So, hang on to  your hats.  I'll try to connect from Serbia, but, since getting Serbian dollars at the exchange here has not been possible, we'll just see  how things go. 

The adventure begins.

Ideology

Nick's note: Our dog, Brody, died today, and so, with permission from myself, here is an updated version of a blog that I wrote a few weeks ago for another website:

I am writing this as a health care provider, a hospital CEO, and a concerned citizen.  In the past we have talked almost incessantly about the 47 million uninsured in our nation, and the lack of funding for domestic issues ranging from education to infrastructure.  The Pittsburgh Tribune-Revue last week wrote about the absurdity of suggesting increases in cigarette taxes in order to provide health care for poor children as a very bad idea because this tax plan would have a negative impact on the poor as well?  That logic escapes me as the pieces of the backwards thinking rings in my head.  Getting people to stop smoking, be they rich or poor, is a very good thing.

An article in the New York Times by Sarah Kershaw opened with this pertinent piece of information,

“The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.”

At our hospital, the decision to treat or not to treat will remain the same: We will treat.

The Washington Post’s Christopher Lee wrote recently that,

“If anything looked like a sure thing in the new Congress, it was that lawmakers would renew, and probably expand, the popular, decade-old State Children’s Health Insurance Program before it expires this year.”

This surely seems like a dream come true for any politician, something that creates a health care safety insurance program for children who otherwise might not have the coverage or financial wherewithal to pay for this care.  What politician would even consider vetoing an already established program that offers health insurance for kids?

Interestingly, President Bush did veto it.  It’s important to note that his veto was not because he is concerned that this program doesn’t work. He has acknowledged that S-CHIP works very well.  He has also indicated that he would not veto it because it is fiscally irresponsible. In fact, this plan is, overall, a very reasonable expenditure. Yes, he objects to any expansion of the plan, but, it appears that this was not the only reason for his veto.

It seems that Mr. Bush’s decision to take this stand is ideological.

The program is diametrically opposed to his philosophy of government.  If you take care of kids, and that plan works, then you can take care of adults, too.  Expansion of government is not something that this president embraces.  But the administration clearly continues to embrace the Iraq war, and that costs money, lots of money.

  From The New York Times, January 17, 2007 by David Leonhardt:

“…For starters, $1.2 trillion would pay for an unprecedented public health campaign” a doubling of cancer research funding, treatment for every American whose diabetes or heart disease is now going unmanaged and a global immunization campaign to save millions of children’s lives.

Combined, the cost of running those programs for a decade wouldn’t use up even half our money pot. So we could then turn to poverty and education, starting with universal preschool for every 3- and 4-year-old child across the country. The city of New Orleans could also receive a huge increase in reconstruction funds…”

It truly is all a matter of ideology?