The Doctor and the Bureaucrat

Manatee County Administrator Ed Hunzeker would surely like to shift some of the blame for his failed efforts to enact a half-cent sales tax by orchestrating an expensive special election in an off-cycle year. Recently, he used his platform to attack longtime Manatee County physician Richard Conard, who opposed the idea, while offering several intriguing alternatives. In doing so, Hunzeker seemed either to be convinced himself, or intent on convincing others that misunderstandings of Obamacare were the primary reason the referendum failed. That seems like little more than wishful thinking. 

Last Sunday, Hunzeker penned a rather testy op/ed, directed at Dr. Conard. A medical practitioner and community activist for many decades, Conard has volunteered time and offered his considerable perspective on issues ranging from public education to county health services. Hunzeker's piece was a response to one that Conard had authored the week prior.

Among many points as to why the proposed plan was poorly conceived, Conard had pointed out that a major component of the Affordable Care Act (Obamacare) was expanding Medicaid to reach more of those currently without healthcare. Hunzeker honed in on this aspect of Conard's argument, seeming to suggest that it was the main pillar of his argument (it wasn't) and likely the reason Manatee voters rejected the plan.

In the piece, Hunzeker applauds himself and the board for what he describes as immense efforts to seek a solution to a problem they saw coming — namely, $9 million in missing monies to support the status quo once the current funding source (a corpus established with the proceeds from the county's sale of Manatee Memorial) expired in 2015. Hunzeker acknowledges that Conard served on a healthcare alliance commissioned to explore possible solutions, only to go on and chastise the doctor, asking, if he's such an authority on health care problems, where has he been while he and the others have been busy trying to solve them.

The answer seems simple. As usual, Dr. Conard made himself available and offered considerable insight over recent years concerning county health care issues. In fact, there aren't many issues that he hasn't been involved with since he began practicing medicine in Manatee County in 1967. Conard was even one of the innovators of the county's original indigent care program, which itself led to the indispensable Manatee Medical Society, who continues to serve indigents today, though on a smaller scale.

To most people, this would seem like an obvious blessing, considering that he's forgotten more about health care than most people will ever know. However, it seems that many of Dr. Conard's suggestions were at odds with other interests, which, in Manatee County at least, is the quickest way to have them dismissed. When the county decided to get a new third party administrator for its employee health care program, Conard reviewed the proposals of the top two vendors (Aetna and Blue Cross/Blue Shield) and communicated his alarm that the county seemed poised to accept an inferior proposal at a higher cost. To say this was poorly received, would be an understatement.

On the half-cent sales tax, Conard also offered some interesting insight far in advance of the special election, including ways that the county could get very serious about its long-professed desire to divert the millions of dollars spent on ER treatment of indigent residents to more cost-efficient facilities, where taxpayers would get the most bang for their buck. From establishing Community Health Centers and getting them Federally Qualified Health Center (FQHC) status with enhanced Medicaid reimbursement eligibility, to creating a Managed System of Care (MSC) for the medically indigent with a 24 hour nurse-advice program, after hours urgent care, and a chronic disease registry, Conard suggested multiple ways that the county could use funds from existing local and state funding, plus new federal monies that would allow us to refrain from further taxing residents.  

What Dr. Conard didn't suggest was the only real conclusion that all of Hunzeker's much ballyhooed planning seemed to produce: continuing to maintain the costly and inefficient status quo that enriches a chosen few, simply by finding a new way to pay for it once the current kitty ran dry. I would suggest that this dynamic was much more of a factor in voters rebuking the proposal than anything to do with what may or may not come of Obamacare. 

Of course, the fact that many taxpayers will indeed already be paying more to fund Obamacare didn't help to sell the sales tax. But then again, neither did trying to slip it by under the wire in an expensive, off-year summer election, or using a highly-misleading association with property tax relief. Clearly, there is plenty of blame to go around and Mr. Hunzeker, who orchestrated the costly election just after receiving an absurd contract renegotiation that will likely cost taxpayers even more, would like to deflect some of it. But attempting to do so at the expense of someone like Dr. Conard is not only misplaced, but somewhat silly. From the reader comments at the bottom of his editorial, that would seem to be a common perception.