Community Hospital Lawsuit & Clovis Resentment

Episode Transcript

Speaker 1 (00:00):
I've been thinking more about this lawsuit that I talked
about yesterday on the show, this lawsuit that was filed
by Fresno Building Healthy Communities and Cultiva La Salude, which
should immediately have set the alarm bells off that this
was a dumb lawsuit, and this was a lawsuit that
was filed against community hospitals, and the thrust of the

(00:21):
lawsuit was basically community hospitals Clovis community, in Fresno community,
they receive government funding in the form of medical and
Medicare reimbursement, and that they have to use the funding
they receive equitably. They can't use it to disadvantage any

(00:44):
one particular group of people, population of people. And the
accusation is well, community hospitals were diverting way more of
their funding to Clovis Community than to Fresno community, and
that that is bad, and that that disadvantages lower income

(01:06):
communities who live closer to downtown. It's disadvantaging communities of color.
Now I should have immediately known that the lawsuit was
bunk just by the fact that Fresno Building Healthy Communities
filed it. Fresno Building Healthy Communities is one of these
various ultra left wing nonprofit organizations that quote altruistically advocates

(01:34):
for some left wing policy or another, but it always
does so in the context of its hand being out.
It always does so in the context of, well, you
should get rid of all police, get rid of all
police within Freseny Unified School district, and you should hire
more conflict resolution therapists that we could provide as long

(01:57):
as Fresny Unified gives us a contract. Oh, a city
of Fresno should lessen its police force and just hire
more mental health professionals that we could provide if the
city of Fresno wants to give us a contract to
do that. So it's always like, here's some left wing cause,

(02:19):
but also we want money. They were, you know, Sandra Seladon,
who's the head of Fresnoe Building Health the Communities. She
was the gal who after after George Floyd was killed
and all the riots were starting in Minneapolis, she favorably
tweeted out a video of a Minneapolis police precinct building

(02:40):
burning with the caption that she wrote on there burned
them all down, So that's great. So that's kind of
the person. That's kind of the person you're dealing with
here anyway. So it's her group is suing Fresno and
Clothes community for this allegedly inequitable distribution of assets between

(03:00):
Clovis community and Fresno community, and the idea that Clovis
community is so nice and fancy and they spent a
million dollars on a chandelier in the waiting room, and
Fresno community it doesn't have enough investment in it. It's
not as nice, it's not as fancy. Blah blah blah
blah blah. All right, now, I was looking at the

(03:22):
lawsuit and looking a skance at it. First. I was
kind of looking askance at it from the perspective of standing,
Why on earth does Fresno building healthy communities? Why would
they have any standing to file this lawsuit? Usually when
a lawsuits filed, you as the plaintiff, have to show
that you've suffered some kind of cognizable harm, that you

(03:46):
are the person who should be here in this courtroom
filing this lawsuit. Okay, the classic example, if someone crashes
their car into my buddy Jonathan Keller's house, Jonathan can
sue for that. I can't sue for that. If I
try to sue because someone crashed a car into my
friend Jonathan Keller's house. There will be a motion to

(04:08):
dismiss and the lawsuit will be dismissed because I don't
have standing. The judge will ask me, well, what are
you doing here? Why are you the plaintiff here? And
also well, I'm really upset for my friend. No, that's
not enough. You need to show some kind of direct
cognizable harm and Fresno building healthy communities, that nonprofit organization.

(04:30):
I don't think it's clear that they were themselves directly
harmed in a clear cognizable way by Fresno Community shifting
assets one way or another between Presno and Clothes Community. Now,
the California rules about standing are weird, and California often
will do things to big time expand the pool of

(04:52):
who can sue for something, even if it's in a
way that goes beyond sort of the normal standards that
we see in most of American law for who can
and can't sue. But the other the other aspect of this, though,
that I certain hadn't thought about, and I'm getting reading

(05:15):
more opinions and ideas about this, is the substance of
the lawsuit I was looking more at the standing and
how is it that Fresno building healthy communities can even
show that they have the right to be in the
courtroom in the first place. But what is motivating these
left wing activists Beyond that? I think there's also the substance,

(05:40):
which is medical reimbursement to hospitals and then shifting money around,
which we have to kind of understand what medical reimbursement
is and what it's like. We had a similar thing
like this with Valley Children's. You know, Miguel Arius and
Gary Bretdefeld were saying, well, look, Valley Children's gets all

(06:01):
this money in medical reimbursement and they're paying their you know,
they're paying their executives all this money. Is that improper? Well,
we got to understand what medical reimbursement represents patients who
have medical All right, let's repetite to Yuvonne repeated things.

(06:23):
Help Medical is California's state version of the Medicaid program,
the federal Medicaid program. Medicaid is health insurance coverage for
people who have lower incomes. I think the number is
if you are at one hundred and thirty eight percent

(06:43):
or less of the federal poverty line. So here's the
federal poverty line. Here's one hundred thirty eight percent of
the federal poverty line. If you're under that one hundred
and thirty eight percent threshold, you are eligible for medical
in California. Ok you are eligible for medical and California

(07:07):
has massively expanded the pool of people who are eligible
for medical. Now it's expanded to everyone, regardless even of
your immigration status. So unlawful migrants, illegal aliens can get
medical coverage in California. Now. The thing is, medical is

(07:28):
a partially federal, partially state funded program. It is a payer.
It functions like an insurance company or a payer. So
in the provision of healthcare, you have the three p's,
the patient, the payer, and the provider. The patient obvious
the sick person. The provider is the doctor or the

(07:52):
nurse practitioner or the healthcare entity that is doing the billing. Okay,
So you have the patient, you have the provider, and
you have the payer. The payer is the insurance company
or the insurance program like medical. So usually in a

(08:14):
private insurance context, the way this circle of life works
is the patient has health insurance, maybe from his or
her work they pay health insurance premiums to the payer.
So the patient pays premiums to the payer, the patient

(08:35):
receives health care services from the provider, and the provider
gets reimbursement for those services from the payer. So that's
the circle of life. The patient pays premiums to the payer,
the payer pays healthcare reimbursements for services to the provider.
The provider provides the services to the patient. That's the circle.

(09:00):
Now with medical or Medicare, Medicare is a purely federal
health insurance program. You don't have the patient paying the
payer in the form of premiums. There's a lot of
peace here, sorry, guys. Medical is funded by taxpayers. Medical

(09:25):
is funded by taxes, federal tax dollars and then California
state tax dollars. That's what funds medical. So Medical has
a certain pot of money from taxpayers which it uses

(09:47):
to pay providers to reimburse them for services. But their
pool of money is only so big, and the number
of people on medical is growing and growing and growing
and growing in a way that outstrips the revenue, the
state tax revenue that Medical has available to it. As
a result, what happens medical pays doctors less and less

(10:10):
and less and less and less in reimbursement for services.
So doctors providers have to make a choice, will we
accept medical patients or won't we If we accept medical patients,
then we have this very large pool of patients who
are all open to us, but we're going to get
less money per patient. And maybe for whatever specific specialty

(10:33):
you're doing, or maybe your business set can be set
up in such way. Maybe if you're seeing x number
of patients per hour and you get things set up
and you're doing this one specialty that reimburses, actually kind
of okay, maybe you can set up a business a
medical practice where you're seeing medical patients and making money.
But on the whole, medical patients don't make doctors don't

(10:57):
make providers don't make. Hospitals a lot of money. In
many cases, doctors, hospitals, providers lose money on medical patients.
That's the problem with Madera Community. Why did Mederic Community
Hospital go out of business Because in Midera County, this

(11:18):
huge percentage of their patient population was medical. They're taking
care of all these people and the reimbursement they were
getting from medical wasn't enough to cover their costs. They
were losing money. That's why I think in the context
of value Children's Hospital, it was kind of silly to
talk about how all there is value Children's misallocating medical
funds to help, you know, sub to pay for you know,

(11:41):
big compensation for their CEO and top executives. Medical reimbursement
is barely covering the cost of the care given to
the medical patient. It's a direct reimbursement for care, and
it might not even cover the cost. So now we
get to Fresno and Clovis community. If the argument is

(12:06):
you're receiving medical funding and you're inappropriately siphoning funds from
Fresno community to Clovis community, then that kind of doesn't
make a ton of sense to me conceptually, because again,
what does that medical reimbursement represent. It doesn't represent a profit.

(12:33):
It's not like community hospitals are making money hand over
fists from medical patients getting rich at the expense of
the state. No, medical reimbursement is barely covering their costs.
If that, they're probably losing money on their medical reimbursements.

(12:54):
So the idea of putting more assets into Clovis community
rather than Fresno community just conceptually this idea that they
are misusing medical funds because they're getting all this medical
funding there, they're putting it all over. Medical reimbursement doesn't
necessarily represent making money. It's not money made. It's reimbursement

(13:21):
for services that in most cases is barely even covering
your costs that you initially have. So this idea that
Presno and Clovis community are wildly you know, oh, they're
just at the expense of the taxpayers, just you know,

(13:42):
making Presne community terrible so that Clovis community can be awesome,
so that they can help all the white people there
and all the development that you know, Darius Assimi wants
to build over there. I just don't. It just doesn't
conceptually make sense that medical funding is being used in
that way. Medical funding is not helping Clovis community to

(14:03):
get to become this super nice hospital. Medical funding is
barely allowing you to cover your cost nobody's getting rich
off of medical I think I think that's the the
takeaway one should have, and it's it's a common sort

(14:24):
of I think it's a common misconception about the provision
of healthcare. Medical is not making anybody rich. All right,
we'll talk about more problems with this and the specific
setup between Fresno and Clothes Community. Next, this is the
John Jerrardi Show. An interesting piece by Edward Smith in
GV wire nonprofits lawsuit against Community Health System misstates medical

(14:49):
funding rules. Now what I've been talking I've been looking
at this lawsuit again. This was a lawsuit filed by
Presne Building Healthy Communities, which is this ultra left wing
nonprofit against Fresno and Clovis Community. Allegations being Fresno and
Clovis Community Hospital receive medical funding in the form of
reimbursements for services provided to medical patients. They are allocating

(15:12):
more funding to Clovis Community than to Fresno Community. This
is disadvantaging the poorer patient population in the area around
Fresno Community Hospital downtown, and this is an inappropriate usage
of medical funds. That's the allegation made by Fresno Building
Healthy Communities. My response to this is, first of all,

(15:34):
I'm not sure how Fresno Building Healthy Communities really has
standing in this lawsuit. I don't see how they're the
ones directly harmed, why they have the right to bring
the lawsuit, Although maybe they do. California has weird rules
about who's allowed to sue. Also, though that medical funding
medical funding basically represents the state kind of helping you

(15:57):
cover costs. But in many cases hospitals lose money on
medical patients. Nobody's getting rich off of medical reimbursement. So
this idea that Presno and Clothes community getting all this
state funding and inappropriately using it to make a ton
of money, I just feel like that's not an accurate
description of what medical funding even represents. Medical funding is

(16:22):
not even really covering your cost if it was private
insurance funding that was going from one place to another place.
Private insurance funny, Yes you're making a profit if you've
got a patient with a good private insurance health plan, Yeah,
that helps you make money. And I think, honestly, what's
more likely to be happening is that I would imagine

(16:43):
Clovis community is helping to subsidize PRESNE community, that the
higher percentage of private insurance has over in Clovis community
are helping community, allowing Presno community downtown to stay afloat.
Now here's the story from a gvwire about this medical

(17:04):
funding at Close Community Hospital falls behind that of other
area hospitals, yet it beats the state average of care
for low incompatience. A gv wire investigation found fifty seven
percent of Close Community's revenue comes from government funded healthcare,
either medical or medicare. Community Health System's decision to invest

(17:26):
more in Close Community than its downtown Presno hospital in
recent years led to two local nonprofit groups led to
local nonprofit groups to sue the network. The social justice
advocates claim that the health system wrongfully diverted medical money
from Community Regional Medical Center, which is one of the
highest rates of funding of that kind in the nation. However,

(17:49):
medical's a reimbursement for care already provided to a patients,
and Ann Mcleared, president and CEO of Private Essential Access
Community Hospital, State and federal laws say that medical funding
can be used where hospital systems deem it most effective.
And while the suing nonprofits say Community is subsidizing Clovis
Community with its better medical reimbursement rates born from its

(18:09):
disproportionate share of low incompatience, McLean says networks rely on
commercial insurance to keep their hospitals financially viable. All right,
so it's also this thing that a big portion of
this lawsuit against community is that they're misallocating funding. Well,
it's one hospital system, and this is the other side

(18:33):
of the argument is no, this is one hospital system.
They're allowed to allocate their funding how they wish. It's
not like and again I was saying, you know, conceptually,
this doesn't make sense. The lawsuit is trying to argue that, oh,
Fresno community is getting more medical funding, You're using that

(18:54):
to help make Clovis community so much nicer. No, medical
funding isn't making money. Medical funding is a reimbursement for
a specific service which might not even cover the cost
of providing that service. It's a terrible reimbursement rate, which

(19:15):
is often obtained through you know, your billing department having
to drag it from medical kicking and screaming. You know.
That's the other aspect of medical reibursement is that medical
is notoriously terrible, extremely difficult to deal with, and is
super picky and wanting to not reimburse you for any
every little tiki taki thing. I remember my dad talking

(19:37):
about this at Valley Children's, Like his billing department would say,
we're spending eighty percent of our time tracking down you know,
fifteen percent of our revenue. And the thing about it is,
you know, fifty seven percent of Clovis Communities revenue is

(20:00):
coming from medical and medicare. This is the other aspect
of this that I think Fresno Building Healthy Communities is
playing on, and we'll get to this in the next segment.
Presnoe building Healthy Communities is trying to play on this
trope that Fresnoe liberals have loved that Clovis is this
place full of evil, rich white people as opposed to

(20:23):
downtown Fresno, which is this enlightened land of the poor,
downtrodden masses, and to foment racial and class animus between
Clovis and Fresno. I'll get to that in the next segment.
This is the John Girardi Show, the central aspect of
this lawsuit against Community Hospital by Fresno building Healthy Communities.

(20:47):
And as more time goes on, the more I'm seeing
like these large flaws in this lawsuit and the more
aspects of it that just don't conceptually make any sense.
But I think with a nonprofit like this, like why
is a nonprofit filing this lawsuit? I think in part,

(21:14):
nonprofits do things not all the time. And I'm not
saying like, you know, I try to I would think
that Right to Life does what it does not to
not purely to get more donor support, but often it's
to get attention and to get donor support. And that's
not what I try to do it Right to Life.

(21:35):
I think what we try to do things that help
people or educate people. But you know, if you can say, hey,
we're this nonprofit doing X, Y and Z, and we
follow lawsuit against a major local hospital chain for blah
blah blah blah blah, and then maybe in the settle
we were able to get a settlement process and convince
them to send more money to president community blah blah

(21:58):
blah blah blah. You know, that would be a significant thing,
or at least a significant thing for them to brag
about to their donors. And I think one of the
things this is playing on, this whole lawsuit, it's playing
on this thing that I think is kind of ugly
in local politics. It's both ugly and reflective of a

(22:23):
very narrow California worldview. And it's this idea that Clovis
is this hopelessly racial. It's this hope that this racial
struggle between Clovis and Fresno, that Clovis is this lily white,

(22:52):
out of touch, rich, subtly racist community, that Clovis the
Pece Flynn Clovis don't really like Latinos, they don't really
like black people, they don't like racial minorities. That Clovis
is just full of Bible thumping white Christians. And meanwhile,

(23:16):
we poor schlubs living in Fresno. We're the real Fresno.
We're the real ethnically diverse, vibrant local community. This tower
district centric, it's this tower district centric view of the world.
I think it's a downtown and tower district centric view

(23:39):
of our region. That and maybe even just the geography.
I mean, I'll admit I grew up in Clovis, so
I don't go to downtown Fresno or Tower District as much.
I mean, I work every day at you know Blackstone,
you know Blackstone near Ashland, So I mean it's not

(24:00):
like I'm disconnected from you know, I work in a
part of Fresno that experiences great poverty. Okay, so it's
not like I'm disconnected from that. You know, we have
a business, you know, we have a second location for
our business at you know, Fulton Street, just south of Olive.
You know, I understand I've been around in these parts

(24:25):
of town. Okay, I'm familiar with them, but I will admit,
you know, growing up, it's not like I was super
familiar with tower districts, not like I was super familiar
with downtown Fresno. It's not like I was super familiar
with you know, way out west, living on sort of
the eastern edge of the city. And I think that
there's a decent number of very liberal people who foment

(24:48):
these kind of class divisions even within the city of Fresno.
I think the kind of there's this antipathy for Woodward
Park area, there is also this antipathy for Clovis, and
Clovis and Woodward Park are sort of painted to be
the same thing, which I don't think is fair. I
think Clothes is very different from Woodward Park. I think

(25:11):
Clovis is more working class. But part of this, the
basis of this whole lawsuit is Clovis community is serving
all these rich white people. Fresno community is downtown, It's
serving all these poor Latinos and black people. And you're

(25:32):
evil for allocating more money over there than you are
over here. Now, whether that is factually true, whether that
is it even makes sense as a lawsuit, whether community
isn't able to allocate funding one way or another. And frankly,

(25:53):
I would suspect that Clovis community is the only thing
keeping Fresno community afloat if anything. But one of the
pieces from the story that I thought was, you know,
shows the sort of lunacy of this sort of weird
vision of our community that local liberals have. Fifty seven

(26:14):
percent of close communities revenue comes from government funded healthcare
medical or medicare, fifty seven percent. And this is the
thing where having not lived in the San Joaquin Valley
my entire life, I think can give me a little
bit more perspective than some of these local liberals. Okay,

(26:36):
I did, in fact go away for a while. I
went to college in India, college in law school for
seven years in Indiana. I lived in Massachusetts for two years.
I was able to travel around the country. I've seen
more of the country than not more than most. But

(26:58):
it's not like I, you know, was born in Fresno,
grew up in Fresno, went to Fresno State and working
in Fresno. Okay, and my experience is of more than
just San Francisco and Los Angeles. People who think that
Clovis is some lily white town. You do realize, if

(27:18):
you picked up Clovis and you dropped it in Indiana,
it would become the most It would instantly be the
most racially diverse city in all of Indiana. Right If
you picked up fres Clovis and you dropped it in Massachusetts,
it would immediately become the most racially diverse city in Massachusetts.
If you picked up Clovis and you plopped it in Pennsylvania,

(27:42):
it would become the most racially diverse city in Pennsylvania.
Not Fresno, Clovis, Yes, Clovis. Clovis is so much more
racially diverse then so much of the country. It has
slightly more white people as it's as constituting their share

(28:04):
of the population relative to Latinos and African Americans, slightly
more than Fresno. But we have so much more ethnic
diversity than so much of the country. This idea in
the heads of Fresno liberals that people like me, okay,

(28:25):
because that's who we're talking about. I am a straight,
white Christian male who lives in Clovis. I grew up
in Clovis, I live there now. I live three miles
from my childhood house. The mindset of local liberals is
that I am a racist. People in my exact demo, white,

(28:51):
straight male Christian, conservative Republican people who live in Clovis
are racist. That we're the center of the problem. Whatever
problems there are, we're the center of it. And what
I'm here to tell you, Okay, excuse me. What I

(29:15):
am here to tell you is that white people in
Clovis interact with, make friends, with care about love, date,
marry in many cases outside of their race, so much

(29:38):
more than so many white people all over America that
it's practically impossible to function as a racist living in Clovis.
The idea that white people in Clovis don't like Latinos

(30:00):
who are This idea that there's racial animus among white
people in Clovis against Latinos is insane. How many couples
do can I think of just at my church where
the one person at my church in Clovis, where the

(30:22):
one spouse is white and then the one spouse is Latino.
I can think of like three or four just just
like like right right there off the top of my hed,
so much so that it's not even remarkable, this idea
that white people in Clovis are these racist, benighted conservative,
evil conservatives. It's you know, I'm glad I had the

(30:48):
opportunity of this lawsuit to talk about it, because I
think it is pervasive in our talk about Fresno politics. Now,
is there stuff that might relate to are there class
divisions within the greater Fresno Clovis area? Sure, there might

(31:08):
be class divisions, and maybe you can make arguments about that.
How did the you know, how the boundaries of Clovis
Unified School District got drawn to include a bunch of
you know, the wealthier precincts of sort of North Fresno
got you know, swung into Close Unified somehow in the
kind of Buchanan and sort of the Buchanan and Clovis

(31:31):
West regions. How that got kind of included in Sure,
you want to talk about class divisions, Okay, that's fair.
I think oftentimes that stuff gets overblown. I think oftentimes
Gary Brettefeld or whoever is in the Gary Brettefeld the seat,
I think he's Fresno City Council district. I think he's
District six, but I'm not sure. Whoever is in his

(31:53):
seat is often hit with the charge of all you
care about is your constituents. You're wealthy, woodward, parky constituents.
You don't give a darn about people who live in
South Presno. Okay, that accusation has been made, and probably
it'll continue to be made, you know, till Kingdom come,

(32:16):
and maybe you can. You can make contentions if you want,
about nimbiism, about not in my backyardism of Clovis or
Fresno being not open to the building of multi unit
dwellings within their cities in ways that are protective of
people who already have homes, who don't want the property

(32:39):
values of their homes to go down, but in a
way that is disadvantageous to lower income persons who need housing,
middle class person people who need housing. All right, you
can you can make arguments like that, I guess if
you want. I frankly think they're overblown. In Clovis. I
think Clovis is that I think Clovis is more of

(33:01):
a working class community than liberals in Fresno would think
but I would say there's much more conspicuous wealth in
North Fresno Woodward Park area than there is anywhere in Clovis. Frankly,

(33:23):
but I think this lawsuit from community, and so much
of local liberal activism, it rests on this concept this
foundation of Clovis is full of racist conservatives, and we
in Tower District we're not. We're you know, we're the

(33:43):
good guys. Those white people over in Clovis are the
racist conservatives, and it's just conceptually ridiculous. That's not what
Clovis is. It's this Fresno's It's this insular Fresno centric
view of the universe that has obviously never traveled to
the Midwest, never traveled to the East coast, and doesn't

(34:05):
actually understand how profoundly racially diverse and accepting this entire
community is, relatively speaking, including Clovis when we return, how
people wildly over and underestimate things in politics, wild over

(34:25):
and underestimation of demographic realities, and how that impacts politics.
Next on the John Girardi Show, there's this interesting tweet
I saw from this researcher named Chris Freeman, who from
West Virginia University published something in the University of Chicago.
Some research journal from the University of Chicago called the

(34:46):
Parties in our Heads misperceptions about party composition and their consequences.
And I've done a couple of shows about this, the
ways in which Americans miss perceive various kinds of demographic trends.

(35:06):
One of the ways this happens is that most Americans
wildly overestimate the percentages or numbers of Americans who are gay,
or transgender, or Muslim or belonging especially various kinds of
minority groups. People wildly overestimate how many people are in

(35:28):
different kinds of minority groups, but especially with like transgenderism,
it's like less than one percent of the population, and
it's it's estimated by most Americans to be something like
ten percent of the populator. It's huge overestimation. This researcher
one of the things he talks about that relates to
this discussion I'm having about how within Fresno, among liberal

(35:50):
liberals in Fresno think of Clovis as this racist, white lily,
white haven. And I think it is a ridiculous idea
that's born of a very insular, California centric view of
the world. If these people actually visited the Midwest, or
they actually visited the East Coast, they would understand, actually
Clovis is remarkably ethnically diverse. Self identified Democrats, according to

(36:17):
this researcher publishing in this journal from University of Chicago,
self identified Democrats believe that forty four percent of Republicans
earn at least two hundred and fifty thousand dollars per year.
The correct figure is two percent of Republicans actually earn

(36:38):
two hundred and fifty thousand dollars per year. Now that's
a that's a profound overestimation. So Democrats think fully forty
four percent of Republicans make two hundred and fifty thousand
dollars or more per year. They think forty four four

(37:00):
percent of Republicans are extreme, are quite wealthy. That is
a wild overestimation, and you can see how that attitude,
that perception would adversely impact politics in our discourse. Democrats

(37:21):
think when they're talking about Republicans, talking to Republicans, thinking
about Republicans, they think those rich fat cats, forty four
percent of whom make over two hundred and fifty thousand dollars.
They think of Republicans, as a bunch of super wealthy people,
and I'm sure that that impacts local conversations too. I

(37:44):
think there's this perception of Clovis a bunch of rich,
white Republican jerks. No, not the case, certainly, not to
the extent that they imagine in their heads. I just
thought that was really interesting, this idea. So Democrats apparently
walk around thinking forty four percent of Republicans make two
hundred and fifty thousand grand a year, and that's just wrong.

(38:08):
And there's so many things like that that I think
misperceptions that impact our politics. That'll do it for John
di already show see you next time on Power Talk