Author: P Hasselbacher

City Air Makes You Free. A Public Health Case for Sanctuary Cities.

The following is extracted (with permission) from an article first published in hasselbloger.com.

In the printed edition of the Courier-Journal on January 25, a letter-writer contributed the following:

‘Dignity of Labor’ to get healthcare is wrong.
According to your report of Jan/ 13, Gov. Bevin wants to change Medicaid requirements to enable the “able bodied” poor to learn the “dignity of labor.” It was a teaching of the Nazis that “Arbeit macht frei.”  The similarity between these two simplistic positions is too dangerous to ignore.  Stephen Schuster, Louisville.

Based on reflection over the past two years, I do not deem Mr. Schuster’s reaction to be overblown.  I submitted my own letter in response, but it appears that it was not accepted. Having my own “barrel of ink,” I publish it below.

Dear Courier Journal.
A recent correspondent to these letters drew uncomfortable attention to a similarity of phrasing used by Gov. Matthew Bevin and the German Nazis.  To obscure an ultimate goal of decreasing Medicaid enrollment, he and other governors would require “able-bodied” beneficiaries to either work or provide compulsory volunteerism [an oxymoron?] under the dissembling cover of gifting the poor with the ability to learn “the dignity of labor.”  Mr. Schuster and I were both reminded of the phrase Arbeit macht frei (Work sets you free) posted by the Nazis at the entrances to their Arbeitslager (labor camps) which evolved into the death camps of Europe.

A much older German phrase entered my mind as President Trump and his acolytes scold and sue cities like Louisville for protecting their inhabitants born under other suns.  Stadtluft macht frei  (City air makes you free.) expresses a centuries-old common law concept of medieval Europe whereby slaves, serfs, or peasants who entered a self-governing city were protected against involuntary repatriation to the rural countryside or servitude by their owners or landlords.  Remaining in such a city for a defined period ruptured the physical and economic bondage of structural rural poverty. Those so sheltered could become Bürger, or citizens.  Cities were places of opportunity!  The concept of a path to citizenship in a sanctuary city has a long and honorable history.

In the late 19th century, the abstraction of Stadtluft was still being used to summarize the motivation of rural Germans wishing to escape the tyranny of their birthplace, their legitimacy, their institutionalized poverty, or limits imposed on their occupations and ability to make a living.  I am proud of the leadership in Louisville and similar cities which protects those living in their jurisdiction against the unleashing of the most ignoble of nationalistic urges.  Louisville should not reopen its workhouse of the early 20th century.

Peter Hasselbacher
Louisville
29 January 2018

Addendum:
I take the liberty of reposting this larger part of my other article in this health policy blog because I believe it is relevant.  Individuals who in the current climate of immigration stings and deportation may be justifiably afraid to respond to demands of “show me your papers,” will correspondingly  be much less likely to seek medical care when they are sick.  This is not good for anyone!  As a people, we are no healthier than the sickest among us– regardless of place of birth.

KentuckyOne Health Has Already Sold Most of Its Real-estate Assets in Louisville.

KentuckyOne’s two acute care hospitals and its business operations in Louisville still remain on the sales block.

Soon after I clicked the button to publish last week’s update on the status of the sale of Catholic Health Initiative’s assets in Louisville, I was told by an anonymous reader that a group of capital investors was the last of potential buyers still in the game. Perhaps naively I have been assuming that only other hospital systems would be interested in acquiring the clinical operations of  Catholic Health Initiatives (CHI)/ KentuckyOne Health in Louisville. I was aware that at least parts of one of the doctors office buildings next to downtown Jewish Hospital had been transferred to a new landlord.  A quick look at the Jefferson County Property Valuation Administrator’s (PVA) website and a bit of Internet research revealed much more.  Beginning in 2015 and finishing in the spring of 2016, CHI sold all of its local medical office buildings and outpatient medical centers (of which I am aware) to a single, investor-owned, national real-estate investment trust (REIT) – Physicians Realty Trust and Physicians Realty L. P.  (Nasdaq- DOC).  I must be the last person in Louisville who knew the extent of these real-estate sales.   This third-party owner is now necessarily a major player in planning the future of not only the downtown medical Center, but the healthcare infrastructure of the Jefferson County region. The rents must flow! Continue reading “KentuckyOne Health Has Already Sold Most of Its Real-estate Assets in Louisville.”

The Search For A New President of UofL Must Be More Open.

The University of Louisville is trying hard to recover from what can arguably be considered its darkest hours.  It has, and is still weathering challenges to its accreditation at several levels.  It has been turned upside down by a string of scandals that may yet lead to criminal charges.  All of this has been well-reported publicly resulting in a community consensus that a lack of transparency and accountability at the highest administrative and governance levels allowed corrupt and abusive practices to fester for years.  Where there should have been openness, there was deliberate obfuscation.  It is against this background that the UofL’s Board of Trustees seeks to appoint a new President of the University using a process that could not be more opaque.  Faculty members, some administrators, and students who have the most skin in the game are openly critical.  I am too.

The descriptors ‘open’ or ‘closed’ in reference to such a search are by themselves poorly defined. However, the recruitment process selected by the Trustees would deliver us as Deus ex machina, a new president to solve our problems, but one who would not be named until after they were appointed.  Such a process meets my definition of ‘secret.’  More of the same is the last thing we need.  The Board is increasingly being criticized for its retreat into opaqueness generally.  Its meetings are carefully scripted and I have yet personally to hear a substantive discussion publicly.  I must conclude, as I have in the past, that all major discussions or decisions occur behind closed doors.  Perversely, even those Trustee representatives of faculty, staff, and students are prohibited from sharing information with their own respective constituencies – or for that matter even sharing their own opinions publically. The assumption of this posture by the Board beggars the concept of shared governance. Continue reading “The Search For A New President of UofL Must Be More Open.”

How Close Really Is KentuckyOne Health To Selling Its Louisville Assets?

Catholic Health Initiatives (CHI) just published its financial report for the first quarter of Fiscal Year 2018– the three months ending Sept 31, 2017.  One initial media report led with what CHI would no doubt wish to emphasize, that the company has cut its “quarterly operating loss by more than half.”  The actual reported system-wide loss from operations in Q1-FY2018 was $77.9 million compared to a loss of $180.7 million in Q1-FY2017. This change is being attributed chiefly to more efficient purchasing and to decreased labor costs.  Indeed, CHI reported a decrease of 2,667 full-time-equivalent employees over the quarter.  Whether such cuts are healthy for the company in the long run remains to be seen.  I await more expert financial analysis than I am able to offer and to see how the financial markets or potential new partners or asset-purchasers react.  It appears these latter are not being hasty.  As I plow through the numbers, I see many other measures going in what appear to me to be the wrong directions.

The report gives special attention to what has been going on here in Kentucky.  [I extracted all mentions of Louisville or Kentucky from the 61-page report into a separate document available here.]  The percent of operating revenues contributed from the Kentucky Region was 7.5% this last quarter compared with 16.2% in 2013. This represents a drop from 2d place to 5th place among the 11 or 12 regions or operational segments.  Perhaps the most newsworthy item is the first notice of which I am aware that the anticipated (hoped for?) date for a closing on the sale of CHI’s KentuckyOne Health facilities in Louisville has been put off six months to June 30, 2018.  A reasonable person might conclude that KentuckyOne is having a difficult time finding a motivated buyer for its hospitals, outpatient medical centers, and physician practices here in Louisville.  I am not surprised. The return of control of University of Louisville Hospital to the University has not improved the financial performance of Jewish/Sts Mary & Elizabeth Hospitals.  With respect to apparently continuing discussions between CHI and Dignity Health to align their activities, the report uses the same language it did at the beginning of this year.  No substantive indication is given as to how things are going.  Although some media reports use the word “merger” to describe the process, that word seems to be carefully omitted in accounts by CHI itself. Continue reading “How Close Really Is KentuckyOne Health To Selling Its Louisville Assets?”