In 1976, I moved to Maui for what I thought would be a brief interlude, but turned out to be closer to four decades of love-hate romance with Hawaii politics. That’s the year I became a general assignment reporter for The Maui News.
Before moving to Maui I had written both staff and freelance for many large metropolitan papers with readership in the hundreds of thousands, even a million or more, so though I was still quite young, I was an experienced working journalist with a fat portfolio and many bylines. People found me cocky because I was cocky.
But no place I had ever worked before has prepared me for the level of credibility that people of the Valley Isle put in The Maui News. That paper was read and believed somewhat in the manner of Holy Scripture.
Some of my early reports for The Maui News were about staffing and financial difficulties at Maui Memorial Hospital. Then, as now, it was Maui’s only acute care hospital. Then, as now, most dollars in its budget were under state control and subject to political manipulation and sleight of hand. Distributing the dollars was up to three groups: Oahu members of the legislature who were in the majority, bureaucrats from the state Department of Health–which in those days ran the hospital–and Oahu union officials.
Those running the show on Oahu had an almost magical belief that 1) Maui didn’t matter and 2) you could fool all of the people all of the time.
Financing the local medical facility was always a shell game at best; that is a rigged game of chance. From then to now, no impartial observer could ever be sure which shell covered the pea, because providing the best possible healthcare to the people of Maui was always secondary to providing the most jobs, the most perks, political contracts and rewards. The name of the game was the ability to steer large sums of public money with little or no scrutiny or accountability. What we got depended on who was in office and who were our friends (or not our friends). It’s called the “spoils system” for a reason, (“to the victor belongs the spoils.”)
Then, as now, there was no limit to the amount of political finagling that went/goes on behind the scenes.
All of this was at the time unknown to me. I was a big city girl, a Detroit native. I was used to asking hard questions and I was used to getting straight answers.
That series of stories about the local hospital eventually resulted in the resignation of the then State Director of Health and rattled the cages of a number of local officials whose positions as administrators resulted directly from their political connections (some still living so they shall remain nameless). In the end, officials created enough full time permanent staff positions to at least temporarily meet the needs of a growing community.
That year we took two steps forward. Pure dumb luck, and it was entirely temporary.
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From then to now the hospital has regularly melted down at least once every decade. But none of the meltdowns have been as severe or as potentially debilitating as the one that the 214-bed Maui Memorial Medical Center (MMMC) faces today.
Most people on Maui are at least dimly aware that cuts have already been made, and also peripherally aware that more cuts are coming. They just have no comprehension of how big and nasty and hard the end game can and probably will be, and how it could affect every single person who lives or visits here.
But to tell the truth it doesn’t matter if the shortfall is $11 million or $30 million or closer to $50 million a few years out (hospitals in Maui County currently bring in $228.7 million a year in revenue). It doesn’t matter how large that sum is, or how it got that way. What’s important now is to understand it will take more money to close the gap than is ever likely to be forthcoming from the state.
All of the decisions on what will happen to the Maui hospital are going to be made by people on Oahu. Roughly $200 million passes through MMMC every year. What the hospital doesn’t generate itself, what it doesn’t receive in reimbursement, is (in theory) made up by the state.
In fact, the hospital seldom receives adequate funding and it almost never knows how much is coming, when or for what.
MMMC is one of multiple hospitals that is in the state system of public hospitals and that this system is the fourth largest of its kind in the nation. Maui is also the largest of the state public hospitals, it wants out of the Hawaii Health Systems Corp. (HHSC), which is the administrative superstructure that is supposed to provide “efficiencies of scale” to the system, but only adds costs, red tape and bureaucracy. The HHSC would have been dismantled years ago were it not–as previously stated–that all public money in Hawaii is political.
In truth, HHSC’s day is (or should be) over. What’s more, one out of every four hospitals in the US will fail, merge or go bankrupt in the next five years according to Becker’s, a leading publication of the health care industry.
What happens to the Maui hospital, (and to a lesser extent Kula and Lanai), its workers, the medical and professional staff, the administration, the unions, the contracts, and to the political system that spawned it and keeps this whole Kafkaesque loop in play, is in the hands of people who do not live on Maui and who only dimly comprehend the impact their actions will have on kind and quality of hospital services available to us here on the Valley Isle.
Oahu will decide what (if anything) in the way of money or enabling legislation comes to Maui. And it will be decided soon. The legislative session opened Jan. 21 and will be over in early May.
The major players are Wesley Lo, the hospital CEO and Rep. Joe Souki, D-Wailuku, the Speaker of the State House. With Souki in the House is Della Au Bellatti, D–Makiki, Tantalus, who chairs of the House Health Committee. Also key is Sen. Josh Green, D–Kona, Ka‘u (the only medical doctor in the Legislature), who chairs the Senate Health Committee.
Other leaders include union boss Randy Perreira, chief of the 42,000-member Hawaii Government Employees Association (HGEA)–Hawaii’s biggest union, and newly elected Governor David Ige.
Then there’s Hawaii Pacific Health, a private, non-profit, unionized health care provider with four hospitals (Straub, Kapi’olani and Pali Momi on Oahu and Wilcox on Kauai) as well as 50 clinics throughout the state. HPH has more than 100 years of experience in Hawaii and is the state’s largest private health care provider.
HPH seems to be the only private sector provider that is willing to look at this hot stinking mess and make a proposal to co-venture with the state. In broad terms the proposal calls for the private side (HPH) providing management and access to capital and the public side leasing the facilities out at a nominal rate. A transitional period is envisioned where Maui could still turn to the state for assistance. It’s conceivable that such a co-venture might not only defuse the financial crisis but eventually make Maui a stronger, better, more financially solvent hospital too.
To that end the hospital and its friends are now girding (for the third year in a row) to seek legislative authorization to pursue, a public-private partnership that could perhaps, over time eliminate the need for state subsidy and put Maui’s only critical care hospital on a sounder financial footing.
Sounds simple, even reasonable, but don’t hold your breath.
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To my surprise, bankruptcy has its fans and I have talked with a number of well-versed intelligent adults who say, “Let it fail and start over.” I do not happen to be a member of that school. If you think there will be pain and glitches attached to Plan A-to partner with a private health care provider – then take a close look a Plan B which comes with the kind of pain that only crash and burn can bring.
So who has the juice?
In the end, it’s Randy Perreira who has the biggest say. He is the man who heads a union with real political muscle and is used to using it.
Of the 1,400 or so people who work at the Maui hospital, a large number of them belong to the HGEA. In fairness, the union has done very well for its members in the past.
Whether it will be able to continue to do that in the future-–as the facility spends down its cash reserves which it now counts in days, not months, and heads for ruin remains to be seen.
It was Perreira who bragged on video that he and his supporters shot down the last two proposals that Maui has had in prior two sessions of the legislature. He now seems intent on stalling, blustering, blowing smoke, and making a series of loud noises that frankly aren’t worthy of a man of his abilities, intelligence and experience.
“We represent more than 2,390 members throughout the HHSC and are concerned about their positions, working conditions and vested benefits if a public/private partnership is formed moving forward,” Perreira said in a prepared statement back in November. “We are also concerned about the community and any impact that changes will have on the health care provided to all of these rural communities. However, at this time, proponents of such an arrangement have not outlined the scope of their intent. We will continue to be part of the discussions.”
Those discussions will soon play out.
Even though the people steering this story want to focus on numbers, money, and labor it is really a story about changing times and ways to achieve more efficient and financially stable management. Because it’s Hawaii there will always be politics, but perhaps under a new regime it will be more about health and less about power.
Whether you like the current management or not also doesn’t seem to matter in the end. Under Plan A–a transition to HPH–they will be calling the shots and would probably put in their own managers after a transitional period. So under Plan A current management is likely to disappear, if not sooner, then eventually.
Under Plan B (bankruptcy), the court would appoint a receiver and the hospital would restructure, likely under Chapter 9, all contracts would be void and if you think you don’t like HPH because there isn’t enough job security and guarantees, you can kiss it all goodbye under bankruptcy.
It’s your choice.
It boggles my mind that I am still writing about this 40 years later. It boggles my mind that I have seen more of Souki and his fellow legislators in the last two months than in the last 20 years. It boggles my mind that I (the product of a pro-labor upbringing and with a solid string of labor credentials of my own) will advocate wholeheartedly for new management and the benefits a public private co-venture can bring.
I dare labor to look beyond the end of its nose to the needs of all of us here on Maui including all of its own members and all of its retirees and all the people who depend on the hospital and all that will be lost if that hospital fails or is forced into failure by selfish and self-serving interests.
My message to Perreira is: We’re not taking it out on you–you’re taking it out on us.
Cover photo/design: Darris Hurst