: Most people on this forum appear broadly in favour of helping out the 'less fortunate'
: But how far would you be willing to go if you were in charge of everything?
We are Not looking for a benign dictator!
It's interesting that you should use healthcare as an example. Let me tell you a little story about our county, a story that is being repeated throughout the country. We had a community owned general hospital managed effectively from 1952 to 1985. It was run by an elected hospital district board. (It was never in debt). In 1985 the operation of the hospital (through the Board of Supervisors & without voter approval) turned over to a private corporation and that corporation in turn became a subsidiary of Sutter Corp. in 1996. Sutter now controls the operating and capital budget of this and twenty-nine other hospitals it has leased or acquired. The by-laws were amended to include the following statement of purpose: "to contribute to the growth, development and financial strength of Sutter".
Well what has been the effect?
Since 1996 there has been a 42% reduction in nursing staff hours. The RN, LVN, and aide to patient ratio has increased to approx. 11-I putting the hospital in the lowest quartile of California hospitals. The use of unlicensed caregivers per patient has increased almost 1000% since 1992. Since August 1997, Sutter no longer guarantees full-time neurological staffing. (which resulted in a death last summer due to having to transport a patient more than 50 miles to the next nearest hospital).
What other "effects"
Executive salaries have gone from $75,000 year when run by county - to current local CEO -(same man) pay package of approx. $500,000. The current Sutter CEO, Van Johnson receives $1.1 million annually. In addition, Sutter has put into place an "Excess Cash Transfer program" which allows Sutter to require the hospital to transfer any generated cash beyond 2 weeks operating costs to the parent corporation. There is no requirement that any of this "transfer" ever be returned. Two million dollars have been transferred each of the past two years to Sutter's corporate headquarters in Sacramento. Last year the profits of this "non-profit" amounted to 7.4 million dollars.
Now we come to the question you raised about "triage" - that is - "the assigning of priority order to projects on the basis of where funds and resources can be best used or are most needed."
When we as a community ran our hospital such prioritization was determined by such quality issues as "bang for the buck" to put it crudely. Should we have a trauma-care unit or a birthing center or hire more nurses. The decisions were straightforward and Solely determined by amount of funding and quality of care issuues.
Now that the hospitals mission has been extended to "...to contribute to the growth, development and financial strength of Sutter", the "triage priorities" have been extended as well. Now being thrown into the mix of more nurses, etc. are such things as: Sutter's advertising budget (into the millions), CEO salaries (into the millions), real estate deals (into the millions) and bank accounts in the Caymen Islands (unknown amounts - but presumably in the millions).
It is quite apparent to those of us living in This county just which priorities receive the most attantion.