Let's imagine your spouse came home and said your homeowner's association got a good deal on a roof replacement. They signed a maintenance agreement so EVERY YEAR they will assess 1% of every resident's salary to a roofing company "who needed it" because they could not compete with firms in 57 other counties without the yearly payment agreement. In addition, the "contract" did not have any specifics on oversight procedures, how the funds were to be spent, or what kind of documentation was required, or whether your neighborhood homeowner's association board would even look at the documentation or question where the funds were spent. AND, every year the Association Board again voted to pay the 1% without knowing exactly what the funds were spent on. Would you think that was a fair deal for your money?
But that is how the local North Lake County Hospital District law and the Board behaves.
In the last two weeks, the North Lake Hospital District Board held public meetings to hear input before hiking taxes by 1 mill on property owners. I call it hiking the tax, because for 45 years, the Board has rubber stamped approval to choose charging taxpayers 1 mill in property tax, when they could have left the millage rate at 0 (zero). So, each year the tax falls to zero, but the Board chooses to reinstate it at 1 mill.
Today the Daily Commercial printed an editorial (see below) saying that increasing the tax was a good thing, buying into the idea that the hospital staffs had said they need the money more than taxpayers. The Daily Commercial apparently "trusts" the hospitals to spend correctly without documentation, audit trails or Hospital Board oversight. Receiving an audited financial statement or form 990 is not appropriate oversight. I have worked at corporations where we had audit rights and walked through vendor internal systems to make sure the funds we spent with them were documented and efficiently used. Again, that is not done by the Hospital District Board.
At least the Board allowed both sides to speak without limits, so everyone got their say. At the end of last Thursday's session, I would have to say the opposition ( and I oppose the tax) became rather heated in their comments, and it even wore me out. Too much.
I previously reported on the first meeting, where they voted to hike the tax by not selecting the 0 option, and then in a duplicate version of the meeting last Thursday, they made the same decision after hearing from supporters and opponents of the tax. The meetings got bogged down in arguing many specific benefits or problems with the tax and how it was spent.
That is because the law establishing the Hospital Tax District Board only says the Board votes on either 0 or 1 mill, and the funds would be split 50/50 between the two hospitals , who then each give 5% of their take (over $5-million for each hospital) to Lifestream. There are NO conditions or guidance on how the funds are being spent, or guidelines on oversight oo the methods used to document the spending, and the Board RARELY ever asks any questions of the Hospitals at the meetings and RARELY ever explains why they vote the way they do. So, when I call them a "rubber stamp" Board, I think that is a good description.
So, I acknowledge that the Hospital staff don't appear to be spending the funds on vacations, and their staff clearly seem dedicated to good healthcare. But, they are "non-profit" hospitals who already were given non-profit status years ago in return for agreeing to provide medical care to the indigent and anyone that needed it.
But, even with the non-profit benefits, they haven't been able to get solvent after 45 years, and the funds are needed for healthcare, why not give the tax to the County Health deparment and let them hold public hearings to distribute the funds directly to needy clinics, and maybe even the hospitals if the expense is justified. But, no, the law says property owners must give up 1 mill of taxes to fund three specific non-profit charities, when I might instead want to give my money to a specific clinic or even to the School District. Look at the HQ for Waterman Hospital, then look at the HQ building complex for the School District, and decide who might be more cautious about spending taxpayer funds.
If you have ever given money to United Way, remember they let you choose who gets it, and they take a tiny overhead charge. AND, they vett and monitor the recipients to make sure funds are spent as promised. But we don't even get that level of oversight from the current tax law or the current Hospital Board.
I have attended School Board meetings for 3 years, and that Board spends a lot of time reviewing costs and budget line items before approving an expense. In contrast, the Hospital Board votes the 1 mill tax and gives checks to the two hospitals with little public discussion or review of just exactly where the funds are spent. I don't blame the hospitals for taking the funds, but I blame the Board and the law for not defining oversight and cost justification objectives to ensure funds are only spent on needed expenses.
So, I think a referendum is in order after 45 years to let the public vote on the tax in a public forum. Lets not let a mostly appointed (not elected in contested elections) Board, and the Daily Commercial decide how your funds are spent. And, the issue should be defined as funding healthcare via the County Health Dept., and not funding two hospitals. Then the hospitals can make their case to the Health Dept. to receive grants.
The only way to resolve this is to get the local Lake County legislators initiate a "local law" that modifies the existing law, or to initiate a referendum. They are having a meeting on Sept. 30th to discuss this issue, as well as other Lake County issues.
So, don't forget to attend the Lake County Legislators Delegation meeting on Sept. 30th in the LSCC Auditorium (not the convention hall) at 1 pm. They actually start at 10am, so I will find out when the Hospital District Issue will come up, and post an update in this blog. Additionally, if you want to speak about the Hospital District issue, you have to send a form to Rep. Marlene O'Toole's office this week to get on the agenda. Attached is the form. Send it to her assistant, Joshua Blake at [email protected] .
Download Delegation Appearance Card-Lake Sept 30 2009
The legislators should improve the process of how the funds are spent, and should initiate the referendum. They should modify the law to 1) change the rate to "0 to 1 mill" (instead of 0 OR 1 mill) , 2) change the governing body to the County Health Dept. 3) define more specific requirements for oversight, documentation, audit trails and how the funds are to be spent and 4) allow the County Health Dept. to allocate the funds to ANY healthcare provider. If they don't improve the oversight and documentation requirements for the spending, we need to elect new legislators AND new Hospital District Board members.
vj
Editorial from Daily Commercial Today, Sept 23
Rising health care costs provoke discussion
The rising cost for health care has nearly everyone thinking.
Politicians and analysts are arguing the merits of various fixes to a system many Americans views as in crisis.
Here at home, the North Lake Hospital District took a healthy step in the right direction.
District trustees approved the hospital tax, next year's budget and to keep the taxing district in place.
Several hundred people gathered for the district's meeting earlier this month to argue both sides of the issue.
The board had a choice: It could tax district homeowners $1 for every $1,000 in taxable property. The board also could have scrapped the whole arrangement.
The board made the correct decision. The owner of a $150,000 would have pay $100 annually in hospital taxes. That figure includes the $50,000 homestead exemption.
Not a bad deal, considering what the community gets in return.
The money Leesburg Regional Medical Center and Florida Hospital Waterman helps pay for expanding health care costs, including indigent care, charity care, bad debt and Medicaid and Medicare shortfalls.
LRMC's total cost increased to nearly $39 million last year.
Waterman faced similar strains to its balance sheet.
No matter what kind of health care reforms are on the horizon, the community has an obligation to take care of its own.
A hospital tax may be unnecessary in the future. If that happens, the hospital district needs to revisit the issue. But until that happens, trustees have an obligation to keep these particular servces healthy.
The best medicine to accomplish that task is through the tax.
A size of patients' bank account or the heft of their portfolios shouldn't be the determining factor in getting good medical treatment.
