The issue that may ultimately doom the statewide T-SPLOST is the clash between the need for regional planning and the ultimate self-interest of rational voters. An economically-rational voter might consider the benefits he or she will derive from their extra penny sales tax and decide it’s not worth the cost.

I think this is part of what underlies the widespread opposition of commenters on this blog, where any post mentioning TSPLOST becomes an opportunity for MARTA-bashing by OTPers, and for “we’ve been paying for it for 40 years now it’s your ” by the smarter and better-looking denizens of intown neighborhoods. I’ve been guilty of that last part myself, not just in regards to MARTA but also Grady Hospital.

In the 1990s, this dynamic played out along Johnson Ferry Road, where Cobb County residents pushed for widening in order to ameliorate rush-hour traffic but Fulton homeowners opposed the widening that threatened their front yards and homes.

With respect to the Atlanta metro area, we should understand that the benefits of a project are not necessarily constrained to its immediate area, but ramify outwards as bottlenecks are relieved, or demand sated elsewhere. OTPers who travel intown or across 285 benefit from the cars taken off the roads by MARTA, regardless of whether they ever step foot on bus or train. However, this type of benefit does not translate across larger regions, such as northwest Georgia where traffic hotspots tend to be local, population density lighter and the areas where transportation improvements receive more money are farther away.

Per the request of several commenters, we’ll open a discussion of Amendment 2.  This amendment would allow the state to tax an extra $10 every year for every car tag you buy.   Notice the word tax.  That is what this is.  You can try to call it a “fee” all day long, but it is revenue collected by state government to fund a somewhat nebulous concept of “trauma care” that is not directly related to the users who pay.  It’s a tax.

But, because most of the legislators have drank from Grover Norquist’s Kool-aid at some point, they can never vote for anything that is a tax.  Thus, the history of this legislature has been to try to make the voters tax themselves via referendums and constitutional amendments.  And, they very much prefer the term “fee” to “tax”.   Amendment two allows Georgians to tax themselves an additional $10 per year, per car.  It doesn’t sound like much, but when was the last time you left the tag office saying “Dang, that was cheap.  I just wish my tax on that car was even more!   What will I ever do with this money left over here on my birthday?”

To make the idea of citizens taxing themselves seem more palatable, the interests behind Amendment 2 are running commercials that are highly explotative of parents who have gone through the worst thing life can ever throw at them -  the loss of their child.  Yet, several of the examples of the child dying after an accident don’t appear to be cases where a “trauma center” would even be helpful if it had been located next door to the grieving parent’s home.   This sets this amendment up to fail my “If it’s ‘for the children’, it’s probably bad policy test.”

Now, let’s talk about the concept of paying “just $10 more” to fund trauma care.   For every Republican who loves to hate the City of Atlanta (let’s face it, that’s probably 3/4 of our readers), think back to when the city reduced police and fire services last year and then said they must have tax increases to restore services.  What was your reaction?  Clearly, the City of Atlanta cut essential services to cause pain on the electorate so that they would be willing to pay more taxes rather than the city finding a way to cut non-essential services.

How is that example any different than getting Georgians to vote to tax themselves an extra $10 for the essential service of trauma care, save the mechanism involved to initiate the tax increase?  I believe it is not.

The fact of the matter is, we elect our representatives to make tough choices.  Governing is hard.  Abdicating responsibility of prioritizing spending based on available revenues by punting the choice to citizens via referendum is now the go-to solution from our leaders.  Whether trauma care or transportation, SPLOSTS or LOSTS, our officials want the burden of funding needed services to come from the citizens rather than to look at cutting existing programs to fund other programs of higher priority.

Amendment 2 is a gimmick, designed to raise revenue by exploiting the fears of parents by invoking the horrible deaths of several Georgian children, as told by their parents.   The method used to build public support for this bill alone should be reason for voting no.  Sending a message to our elected leaders to actually lead, and make some tough choices instead of deferring the heavy lifting to an already overtaxed electorate should be enough of a reason to remove any remaining doubt.

I’m voting no on Amendment 2.   I expect it to pass.   And much like Super Speeder before it, I expect no significant change in Georgia’s trauma network/delivery well after the funds have been collected.  And spent.

A couple of years ago, when Grady Hospital’s financial troubles could no longer be ignored even by suburban Republicans, a series of compromises was made on all sides to place Grady on tenable financial footing. The major concession by Grady was a complete reconstitution of its board of directors.

Marta stands next in line for the Grady treatment, according to the AJC, with an amendment to SB 22 poised to remake the Marta board. Again.

House Speaker pro Tempore Jan Jones said that the legislation (an amendment to SB 22) would reduce the current MARTA board from 18 to 13 voting members, with three appointed by the state. The governor, lieutenant governor and speaker would each appoint one voting member to make up that three. In addition, the Department of Transportation commissioner and the Georgia Regional Transportation Authority director would have non-voting seats.

Jones said it was to ensure balance on the board and make sure Fulton and DeKalb taxpayers were protected.

According to a copy of the amendment, this is how the 13 voting seats would break down:

State – 3

City of Atlanta – 3

DeKalb County – 4 (at least 1 from north DeKalb, at least 1 from south DeKalb)

Fulton County – 3 (1 from south Fulton, 2 from north Fulton)

Jones pointed out that nearly all of Fulton County’s population lives in municipalities, so it only made sense for mayors to make the appointments. She also said it was about protecting taxpayers.

I recommend clicking the link and reading Ariel Hart’s entire article, to get the true flavor of the points of contention, and the motivation for the change.

Jan Jones is still trying to deliver fiefdoms for a still non-existant Milton County, making Fulton/Milton significantly “more equal” than DeKalb in the allotted board seats, presuming that the City Of Atlanta doesn’t select board members who live in the sliver of Atlanta that encroaches into DeKalb.

There is also the question of what MARTA receives for this new board setup. When Grady was forced to accept a new board, it came with new funding avenues. There was a nice carrot to accept that stick. The changes at MARTA seem to be mostly stick. I’d love to be a new board member at MARTA who would understand with my new appointment that I would be running an organization where the beatings will continue until Morale improves.

Should this amendment pass and become law, I have a quick suggestion for one of the appointments at the State level. The Gov, Lt. Gov, or Speaker should appoint Dick Williams to one of the seats. He would balance the ratio of DeKalb/Fulton ratio, lack of transportation planning is one of his greatest pet peeves, and it would give him some quality time with Representative Jill Chambers, should she be re-elected.

The material that this appointment would provide may not change MARTA one bit, but it would certainly liven up Sunday mornings again.

Sam Massell, president of the Buckhead Coalition and former Mayor of Atlanta, has decided to weigh in on the proposed split of Milton County from Fulton with a “No” vote.

After Massell was defeated for re-election in 1973, he became the defacto voice of the Buckhead and North Atlanta areas, and is still affectionately known as Buckhead’s mayor.

His position, issued via the following press release, is significant because it represents somewhat of a shift in the coalitions that make up Fulton County Politics. Massell could often be counted on by those who felt their interests were not being represented at City Hall to be their point man, and he could often be counted to raise (and resolve) issues on their behalf.

But with Massell favoring the status quo for Fulton, he now finds himself squarely aligned with those at both City Hall as well as those in the Fulton County Government complex.

Time will allow a proper measure of the seismic nature of this shift, but as of now, Buckhead’s power center is aligned with Fulton, and not the folks North of the Chattahoochee.

Full press release here:

Former Atlanta Mayor Sam Massell Says Georgia Taxpayers Will Foot the Bill for New Milton County

Legislation to Create New County will cost Georgia Taxpayers $6.3 Million for starters and $3.2 million annually

Last year, under the direction of the Georgia General Assembly, the Carl Vinson Institute of Government and the Andrew Young School of Policy Studies analyzed the “potential” impacts on state agencies of creating a new Milton County. The purpose of this study was to review the feasibility of implementing House Resolution 21, authored by House Speaker Pro Tem Jan Jones. The two institutions identified all state agencies that may be impacted, then contacted Commissioners and Directors of those agencies to participate in a survey to guage the impact.

The study revealed that first-year state agency costs would reach an estimated $6.3 million, and subsequent annual costs for ongoing services were estimated at approximately $3.2 million. This does not include the costs for instating other constitutional officers such as the Sheriff, District Attorney or Judges.

“I think the citizens of Georgia should be aware that this is not just a local issue for the City of Atlanta or Fulton County,” stated former Atlanta Mayor Sam Massell. “While it is true that the City and County will suffer the effects of creating a Milton County, it is Georgia taxpayers statewide who will ultimately foot the bill for it.”

Massell, who is Chief Executive Officer of The Buckhead Coalition, pointed to the disturbing state of Georgia’s economy as a big concern. State elected officials have all said that this year is a year when every dollar will count.

“Our state is facing terrible cuts in education, cuts that will force university system tuition increases for students and their parents. There are thousands of transportation projects across the state waiting for funding. Teachers and other state employees are facing lay-offs. Given the extreme state of our economy, why would any public official advocate that Georgia taxpayers be charged an extra $6.3 million for services for a portion of the state that has only 300,000 residents, and includes the 9th wealthiest community in the country? That’s a question that every Georgia taxpayer should be asking their state legislator,” he added.

Examples of What $6.3 Million Could Fund:

* $6.3 million would protect half of the University of Georgia’s Cooperative Extension Services – services that support the agriculture industry in Georgia which contributes $92 billion annually to the state’s economy. It would also protect the Archway Partnership Project ($1.1 million) that addresses agricultural and environmental needs in local communities. There are Archway projects currently in Colquitt, Washington, Glynn, Clayton, Hart, Sumter, Pulaski, and Whitfield Counties. Cuts to these programs are currently being considered.

* $6.3 million is equal to approximately 10% of the funding allocated in 2008 by the Georgia General Assembly to stabilize Georgia’s trauma care system. Funding is still needed, despite the $23 million in funding expected to be generated by the new Super Speeder law. Enhanced trauma care is greatly needed particularly in the southern part of the state.

* The Georgia Association of Educators indicates that the average teacher salary in the state of Georgia for 2008-2009 was $53,270. $6.3 million would save the jobs of some 119 classroom educators across the state.

* Columbus State University is facing potential budget cuts that could force lay-offs of 44 members of the faculty and staff, including tenured professors. The school has been directed by the University System of Georgia to cut $6.1 million from its budget.

And it is again not for something good.

A package containing confidential medical records sent via UPS to an address on Canterbury Lane in Lawrenceville ended up at the same street address only in Fayetteville.

The package contained the records of more than 40 Grady Memorial Hospital patients including names, Social Security numbers, medical conditions and diagnoses which were meant for a workers’ compensation office in Lawrenceville called MCMC.

Not good.

Water tests confirmed Thursday that two units at Grady Memorial Hospital were the source of the bacteria that caused Legionnaires’ disease in four of the facility’s patients.

“We’re comfortable right now that it’s only the two units,” said Dr. Leon Haley, deputy senior vice president of medical affairs at Grady. Haley said it was the first time in Grady history that the downtown Atlanta hospital has been the source for Legionnaires’ disease in patients.

“Grady Memorial Hospital officials are investigating a spike in Legionnaires’ disease. Four patients who were recently hospitalized at Grady have contracted the bacterial infection in the past month, according to Grady’s Web site. In a typical year, the hospital might see two or three cases,” reports the AJC.

As a Peach Pundit public service: if you have been hospitalized at Grady in the last month and you think you may be currently ill with Legionella, please call (404) 616-0600.

From this story in the Emory Wheel (admittedly from a few days ago):

Despite tight economic conditions, Emory will forgive $20 million of the $62 million that Grady Memorial Hospital, one of the largest public hospitals in the United States and Atlanta’s only level-1 trauma center, owed to the University since Jan. 1, 2008.

Sarah Goodwin, director of media relations for health sciences communication, wrote in an e-mail to the Wheel that this decision will require Emory to make some sacrifices because the portion of the debt that will not be paid back constitutes nearly one-third of the total and is ultimately “foregone funds” to Emory Healthcare and the School of Medicine.

And I only mean that with half of the sarcasm that the headline may express.

I pretend to be an expert on many things.  One area that I do not attempt this is our bizarre and complex system of health care and its funding.    While our country still manages to deliver the world standard for medicine, the way we do so, and more specifically, the way we fund it, appears to be overly complex, bureaucratic, and inefficient.

I’ve been warning for years that if Republicans don’t come up with some kind of market based reform of the system, we would ultimately accept the reforms the democrats give us.   At the national level, we’re probably on the verge of that. 

But at the state level, Republicans are still in charge.  And the man most in charge, Governor Perdue, has apparently decided that the best way to generate the additional money hospitals need for a statewide trauma  network is to tax the hospitals themselves.

Wait, what?

Perdue has proposed a 1.6 percent fee on hospital revenues and health insurance plans to fill the state’s $208 million hole in Medicaid this year, and to provide $60 million toward a statewide trauma network.

Perdue told legislators he knew his plan would “not be universally acclaimed,” but said the federal government, “in its infinite wisdom,” created the problem. New federal law going into effect later this year would require the state to charge private insurance companies the same fee it charges the HMOs that serve the state’s Medicaid and PeachCare populations. Georgia charges its Medicaid HMOs a 5.5 percent fee on revenues. The state leverages the money from those fees to qualify for a federal match.

Rather than lose the federal match, making the Medicaid situation that much worse, Perdue opted to extend a 1.6 percent fee to hospitals and health insurance plans and recreate the “super-speeder” idea, which would impose a fine of $200 on those found guilty of driving more than 15 mph over the speed limit. A similar plan failed in the final days of the 2008 legislative session.

O.K., to raise money for hospitals, we’re going to tax those same hospitals, plus the insurance companies that reimburse those hospitals when they are lucky enough to have a “paying” customer.

The Governor adds this word of caution when judging this plan:

“Like most things we address here at the Capitol, this plan will not be universally acclaimed,” Perdue said. “But, I have arrived at this solution after thoughtful, careful deliberation. I implore you. Do not rush into a short-sighted cut that would have long-term consequences for Georgia’s most needy.”

O.K., I’ll try to give the Governor the benefit of the doubt here.  Perhaps I cling to logic too much, and am thus defeated in my understanding of this fix to an illogical system.

So, Peach  Punditers, I need your help.  Someone please help me understand how the  best place to get funds needed for medical care is from those who provide said care.

The money vacuum that is Grady Hospital is about to have another Captain at the helm.

For her part, [Lisa] Borders said she planned to spread the message that Grady is “an incredible resource and asset,” not only for those in need of health care but as an important part of the area’s economy.

“We have an opportunity as a community to lift up this resource, polish it and relish it,” she said.

And she’ll be asking for the money to do it.

Good to see nothing is going to change.

Any Job.  Really, it doesn’t matter which one.  Marta, Grady, heck, put me in charge of sanitation.  I don’t care.  Don’t worry about my qualifications, because the person I’m replacing apparently didn’t have any either.  Just make sure I get the severence package that Pam Stephenson got from Grady, or Richard J. McCrillis got from Marta. 

I promise to do some traveling to conferences around the country, learn why Atlanta’s infrastructure isn’t working, hire a few relatives, plea for state funds that will be totally unaccounted for, and then bail with a nice parachute.  I promise to leave things even more messed up for the next guy/gal, so that they can demand and even bigger severance package when they sign on, thus continuing this circle of life.

That should be the new meme! Grady Hospital equals Macon, GA. Both get out negotiated.

Stephenson’s contract, with an annual salary of $600,000, stipulates that should the new hospital board replace her within the first year, she would be paid the remaining amount in the two-year contract. Should she leave in September, that could mean a parting check of about $750,000 or more.

News of the two-year contract has created concerns —- and objections —- among some Grady officials. The agreement was executed by the Fulton-DeKalb Hospital Authority, of which Stephenson is chairwoman, and was signed by Geoffrey Heard, vice chairman. Stephenson also serves as vice chairwoman of the new hospital corporation, the entity that assumed control over the hospital in late May.

Steal the patient’s jewelry!

Atlanta police got an arrest warrant Wednesday for a Grady Memorial Hospital employee they believe took wedding and engagement rings from a woman who died in a car crash late last month. Police believe the man, Tacuma Jawara, 54, of Atlanta is on the run and avoiding capture.Jawara is a social services representative at Grady, where 35-year-old Katherine Armstrong was airlifted April 30 after a wreck on I-85 near Flat Shoals Road, Atlanta police Detective P.J. Roberson said. After Armstrong’s death, her wedding and engagement rings — valued at $5,000 — were discovered missing.

You’d have thought they’d think of this.

The fired CEO of cash-strapped Grady Memorial Hospital said the facility owes him $2 million in severance pay.

A lawyer for Otis Story, who was earning $600,000 a year, said he is negotiating with Grady.

The issue may focus on whether Story was fired for good reason and whether the Grady board members provided him with written notice and a chance to defend himself. His attorney said they didn’t.

If he was fired for cause, he gets no severance, but a hearing process is required.

When Story was fired two weeks ago, after less than a year in the job, Grady board chairwoman Pam Stephenson did not cite any failure on his part. The board, she said, wanted a change in administration.

What lunacy. Damn the legislature if they even hint of giving Grady until this situation is resolved.

Fulton and DeKalb weren’t aware their approval was needed:

Several Fulton and DeKalb commissioners said Grady officials only recently alerted them that their approval is needed, and they are moving quickly. Some commissioners said they learned about it when they read it in 1he Atlanta Journal-Constitution.

In addition, the AJC has obtained a copy of an internal county memo giving legal advice to the DeKalb Commission, which raises nine additional issues related to the lease agreement.

The Jan. 30 memo calls for DeKalb and Fulton to have power to approve the Grady budget, and that the contract between Grady and two counties be renegotiated before DeKalb signs off on the lease.

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Grady fires its CEO and hires a legislator with zero experience to run the hospital.

The Grady hospital board ousted Grady chief executive Otis Story Monday night, effective immediately, and his position will be filled temporarily by the board’s chairwoman, state Rep. Pam Stephenson.

Stephenson took over Tuesday and immediately met with staff.

The decision to fire Story apparently was made in a late meeting Monday. It followed the Grady board’s vote to approve a long discussed plan to transfer daily management of the hospital to a nonprofit corporation.

Story is leaving after less than a year in the post, marking another speedy departure of a Grady CEO trying to turn around the financially imperiled medical system. Stephenson is the fifth CEO of Grady since 2005.

Story’s relationship with the board has been troubled for months.

“The board decided to change its administration,” said Stephenson. “The board members asked me to serve and I agreed.”

Stephenson said she will give up her law practice to become a full-time executive for Grady and to continue to represent parts of DeKalb and Rockdale counties in the General Assembly.

Stephenson has a master’s degree in health planning. She served five years as executive director of the Georgia State Health Planning Agency, where she was responsible for regulatory oversight of all hospitals in the state.

I wonder if Vincent Fort cooked up this deal.

With their new plan. We’ll see how well they can keep this thing moving forward. I think they are headed in the right direction, but do have some concerns about the viability of the plan.

On Grady’s restructuring plan.

Interesting look at Grady’s ties to Morehouse and Emory.

Fifty years ago, Dr. Nanette Wenger came to Grady Memorial Hospital with a degree from Harvard Medical School and a new husband. Today, she’s a professor at Emory, a nationally recognized cardiologist —- and still a Grady doctor.

On a recent winter day, as she darted between examination rooms, she wore a button proclaiming that “Grady is Vital,” the mantra of supporters who rallied to the financially imperiled hospital’s defense when the Fulton-DeKalb Hospital Authority was debating its fate.

The authority, which runs Grady Health System, responded to doctors and other advocates by voting unanimously to hand over management to a private, nonprofit corporation.

It’s a move expected to spur millions of dollars in aid for the 115-year-old hospital. But the restructuring could also change the relationship between Grady and Atlanta’s two medical schools.

it seems to me, however, that those ties do need to be re-examined, especially in light of Emory’s billing this past year.

“Fulton commission refuses Grady $99M in funding”, the ACJ headline reads.

Fulton County Commissioners today refused Grady Memorial Hospital’s request for $99.2 million in 2008 —cash hospital officials said was desperately needed to keep the ailing hospital afloat.

Instead, the board agreed to $80 million, plus $5 million in reserve funding if Grady meets certain management goals.

The amount matches what the county paid Grady in 2006 before approving $20 million in emergency funding last year.

Grady officials warned that any cut could have dire consequences to a public hospital already facing huge debt, problems with cash flow and challenges with patient care. Officials said patient care could suffer, nurses not be hired and vendor payments delayed.

“There is no plan B,” said Dr. Christopher Edwards, a Grady board member. “There is no more cutting we can do. We are at bare bones here. At the end of the day, if Fulton County decides to withhold, we are done.”

The decision came after more than two hours of dramatic debate as commissioners debated Grady’s financial condition and its patient care.

It still seems dumb to me that Grady’s strategy amounts to an all or nothing push for a deal that other people have to pony up for.