The failed attempt by former Mayor Megan Barry to downsize Nashville General Hospital has meant no candidate for the city's top job is following her lead. Even the conservatives in the race say it's not a matter of whether to keep General Hospital, but how.
That led us to ask:
How would you handle Metro General Hospital and its funding?
Many candidates have history with the hospital. Some were born there or are regular patients. Political newcomer Carlin Alford is even cousins with the former CEO, Reginald Coopwood.
Metro Council member Erica Gilmore was involved in last year's campaign to keep the hospital open and says the city just hasn't invested enough money.
"We just want to be clear that it was never misused, but we are looking at new models to help generate revenues," Gilmore says.
The current mayor, David Briley, recommended a larger subsidy for the hospital next year — $44 million — in the hopes it would not need yet another mid-year cash infusion. He says stable leadership at both the hospital and Meharry Medical College, which owns the building and provides many of the doctors, should set the stage for improvement after years of uncertainty.
However, Briley says it's not just a matter of increasing the city's investment. He'd like to see the subsidy go down over time.
"The issue is, are we spending the money as efficiently as possible?" Briley says. "I think there are some improvements to be made there, and I'm going to push them to do that."
For years, city officials have brainstormed about developing some kind of specialty, but it's difficult because there's so much competition just a few blocks away. Vanderbilt has the region's trauma center and burn unit. Saint Thomas has a reputation for delivering babies. Centennial has a bit of everything and deep pockets as the flagship of HCA.
Former Vanderbilt professor and conservative pundit Carol Swain says she would use that competition. Specifically, she says she's talked to the former head of Vanderbilt Medical Center, Harry Jacobson, about helping advise General Hospital.
"He's an expert. He created the Vanderbilt-Meharry Alliance. He knows all the players and all the actors. And he knows health care. "
Jacobson was on the hospital authority's board as recently as last year. However, Vanderbilt has some baggage with General since — for a time — it had oversight of the hospital's management.
State Rep. Harold Love Jr. knows that history and has done more homework on the finances of the hospital than most. His priority as mayor would be first ensuring the hospital gets all its due from the state, which draws down federal money for treating the uninsured.
"We (will) make sure that every dollar that Metro Government gets from the state for the services provided at General, go back into General."
Whoever wins will have to address General Hospital, since Metro's current budget crunch means any additional funding for the hospital will likely have to take away from some other city service.
How would you handle Metro General Hospital and its funding?
Carlin Alford: "We need to continue funding. ... Closing it down is not the answer. So immediately the first answer is, yes, continue funding. Meanwhile one of the ways that I believe that we can help generate an additional revenue stream is to bring specialized services into General Hospital and allow it to be a regional specialty center that could generate funds above and beyond what they're doing right now."
David Briley: "We have provided in this year's budget sufficient funding for them to make it through the next fiscal year without coming back for a supplement. I've met with [CEO] Dr. [Joseph] Webb at the hospital and Dr. [James] Hildreth, [president] at Meharry, and charged them with working together to come up with a solution that makes sure the hospital is run the most efficient way possible and over time reduces the city's obligation to fund it and provide the same level of service. And they both offer that they believe they can do that over time."
Ralph Bristol: "It should be the single most cost-efficient healthcare delivery system in the city, and if it's not, there must be a good reason for that. And I wish I knew the reason, but I can tell you I'm going to find the reason."
Julia Clark-Johnson: "Metro General Hospital, I understand, is having financial difficulties. I would do what I can to support that institution, maybe set aside some type of emergency budget just in case they need extra help."
Erica Gilmore: "We really needed to give it the money just to stabilize it. So I feel like it's in a good place. So I feel like the funding is going to happen. The mechanisms are being put in place so that we can be responsible."
Albert Hacker: "I don't have the exact answer, but I don't think anyone has the exact answer right now. If they say they do, then they should probably present it. Otherwise, let's work with people that are trying to fix it and arm them with skill sets that we can bring to help hopefully benefit that situation."
David Hiland: "I think you keep General Hospital. It's a place where people, if you don't have money, where do you go? You gotta find a way to keep it, because you can't just let people with no insurance, you can't just let them die on the side of the street."
Harold Love: "So then how do we deal with General Hospital? We keep it open. We fund it properly, and we make sure that every dollar of reimbursement that Metro gets from the state goes back into General Hospital."
Jeff Napier: "I really don't know a lot of that area. But from a business standpoint, I would think that we could open that up to where it's more available to more people in general and convert it into a profitable type hospital."
Jon Sewell: "I'm not well enough informed on that. But I would say it obviously serves a duty to the community. It needs to be fully funded."
Jeff Obafemi Carr: "Why we don't have a marathon for General, I don't know. Why we don't have a music fest for General, I don't know. But there are creative ways that we can use to bring people together across lines to support making General one of the top hospitals in the country."
Carol Swain: "I think that over the course of the year, we would have Dr. Jacobson [former head of VUMC] being a part or leading that strategic team that would look at the problem. And so that's what I would do."