Let's say you work at Erlanger hospital. Maybe you're a technician, or a nurse. And you love your job.
At dinner parties, after too much Pinot, you whisper to people how you'd even work for free if you could; you love your job that much. Helping people get well. The exhilaration of hospital work. Caring for others, especially those who can't rub two pennies together.
But lately, it's gotten tough. Your pension's been changed, your benefits, too. On Friday came the latest gut punch: no accrued vacation days from now until July.
You'd be angry, right? Ticked off? Depressed? You might even feel ...
"Sickened," one employee wrote.
The perfect word: sickened. The entire system of health care is sick right now, and this accrued-vacation-day freeze is just the most recent domino to drop.
How do I know? Because look at what's coming next if this mess isn't fixed.
"What I really don't want to see happen is huge layoffs," said CEO Kevin Spiegel, "and service cuts."
Not long ago, Erlanger management met on a Saturday and again on Sunday, looking for ways to reduce immediate debt and stay in the good graces of bond agencies. Freezing accrued vacation days for all employees -- yes, executives, too -- will save $5.4 million, or $600,000 a pay period.
(Hospital budgeting is like playing craps with one hand and blackjack with the other: there are so many variables, so many things out of your control. Take Mother Nature. When it snows, more people stay at home and indoors, which leads to canceled outpatient surgeries, fewer traffic accidents and an empty ER ... and a reduced bottom line. Had our winter been snow-less, Spiegel doubts the accrued vacation freeze would have been necessary).
But vacation days are not really the issue.
"Someone has to pay for this health care," said Spiegel.
Erlanger has long been the medical underdog of sorts: loyal to its mission of being the main hospital in town (despite others, with all their crucifixes hanging on the walls) to carry on its back the poor and uninsured.
But it's getting harder to do that. This year, Erlanger expects to give away $91 million in uncompensated care. This same year, Erlanger's already lost more than $14 million in funding from state and federal governments.
It went dry when the federal sequestration cut $2 million. Nashville legislators cut funding to TennCare Cover Kids. BlueCross cut reimbursements on lab payments. The Affordable Care Act cut another $1.2 million in mandated reductions.
The worst came on Jan. 1, when the feds ended their disproportionate-share hospital funding to Tennessee, a move that cost Erlanger $8.5 million, Spiegel said. It's the latest en-garde in the ongoing duel between our state and the Obama health care administration.
"There is this force between the White House and the state Legislature that is making it very difficult to run health care in Tennessee," Spiegel said.
Next week, Spiegel travels to meet with federal officials about ways to reinstate the disproportionate-share funding, and is very hopeful about the meeting. He's spoken with members of the Hamilton County delegation in Nashville. He's met with both the city and county mayors, asking them to include $5 million in their respective budgets that then would lead to $20 million in matching federal funds.
Spiegel's proactive, upfront and aggressive, in the good way. And if two particular things happen -- disproportionate-share funding restored and Gov. Bill Haslam is able to find a way to expand Medicaid -- then he sees a wonderful future.
"The outlook of Erlanger is not going to be good but great," he said.
Until then, maybe we need a little spoonful of anger to help this go down. Like the red line of mercury that busts the top off the cartoon thermometer, we need to be so red-faced hot that politicians from Chattanooga all the way to Washington understand how significant this hospital is.
Yes, fund it -- really fund it, not this piddling level of funding in place now -- in the county and city budget.
Yes, expand Medicaid in Tennessee and don't fear the dogma that says not to.
Yes, restore federal payments.
And then, restore those vacation days. Even throw in a few extra.
Because you've got some people at Erlanger working really hard who've earned them.
Contact David Cook at email@example.com or 423-757-6329. Follow him on Facebook and Twitter at DavidCookTFP.