I Am Starting To Worry

I Am Starting To Worry


Leonard Zwelling

         Obviously, like all Americans, I am watching as President-elect Donald Trump begins to form the government that will be serving the American people at noon EST on January 20, 2017. His first appointment of Reince Priebus as Chief of Staff was both sobering and welcome. While Mr. Priebus’ politics are not mine, he does believe in political process and understands how government works. The second appointment of Steve Bannon is a little more concerning as he is a bit of a bomb thrower and as a Chief Strategy Advisor with a direct report to the President, this is quite alarming. He is a major player in the alt-right, new nationalistic xenophobic movement and his tactics and politics are not consistent with the values of most Americans, even if he becomes a hero to the hard right conservatives.

There will be many battles within the White House over the direction to take on many critical issues. There will be those who wish to pull back from the inflammatory rhetoric of the Trump campaign. They will be focused on getting things done by appealing to the people who will then push their representatives to fall in line. Ronald Reagan perfected this strategy.

There will be others who will see Trump’s popular vote loss and slim margin of victory in the Electoral College as a “mandate” giving the new president a free hand in reversing executive decisions of Mr. Obama and adding more of his own. An American President has a great deal of power that he (or she, if ever) can wield without the input of Congress. This would be a mistake, but if the Breitbart graduate Bannon has greater access to the President’s ear than his new Chief of Staff, this is likely.

         The warning signs are also ominous. If Rudy Giuliani is the Secretary of State with Jeff Sessions as Attorney General (a guy rejected for a federal judgeship 30 years ago), and Ben Carson at HHS, I will be officially concerned. It is not their politics that so troubles me. After all the GOP won the whole government enchilada and are one appointment away from swinging the Supreme Court hard right. These potential appointees are not the sharpest knives in the drawer. They simply do not have the wherewithal to carry out the duties of leading a major governmental agency. Newt Gingrich is also in the running for several top posts. He too, while a cagey politician, is a little long in the tooth for a major Cabinet post. Chris Christie for Transportation? And they wanted to indict Mrs. Clinton. Christie may well be indicted himself if any evidence arises that he was aware of the George Washington Bridge shut down that just likely sent two of his former colleagues to prison.

         I am afraid the names that are being floated by the press are of great concern, but let’s see what the President-elect actually does.

         What about that other President-non-elect? You know the one at MD Anderson who appears to have vanished into thin air as his charges take the brunt of having to convey the bad news about the institution’s finances to the faculty and staff. My understanding is that the gap between the budget and actual amounts of revenue widened in October (a true $60 M shortfall) after the $40M schism of September. This is not good and the leadership keeps beating the faculty with the notion that those beatings will not stop until morale improves. Again, there are real questions about the wisdom of the strategy to create MD Anderson locales around Houston and the country. These non-MD Anderson MD Andersons may be taking patients away from 1515 making the ukase to see more patients impossible to fulfill because there may not be more patients to see. Even if there are, EPIC is slowing everyone down and my sources are telling me they cannot move a whole lot faster and still close out the charts as is desired by the finance gurus while still keeping the Press Ganey patient satisfaction scores up. I am not sure any of this is even possible.

         What is definitely possible is to offload a recurrent cost of a major nature if the budget warning signs are flipping from yellow to red. How about halving the salaries of these folks given their clearly sub-optimal performance in the clinical arena and in managing the financial well-being of MD Anderson:

Ronald DePinho                          $1,439,100 (more than the Chancellor)

Ethan Dmitrovsky                            829,200 (much more now)

Tom Buchholtz                                  829,200 (also more now)

Dan Fontaine                                     708,800 (probably more now)

Steve Swisher                                     900.314

Patrick Hwu                                       580,000

Steve Hahn                                          708,550

Dave Tweardy                                     499,550

Stan Hamilton                                     518,741

Cindy Schwartz                                   372,654

Marshall Hicks                                    668,445

Tom Rahlfes                                         611,396

Ernie Hawk                                          478,100

TOTAL                    $9,144,050 (and that is probably far less than the current total will be for fiscal year 2016-2017)

         These numbers are all from the Texas Tribune web site and are probably a year or more old so add at least 5% to them all if not more (https://salaries.texastribune.org). In other words, a 50% salary cut for these leaders would generate $5M to the bottom line every year and that should be true until the institution is out of the red.

         If you really want to close that budget gap, spend less on people who are performing poorly as the continuing shortfall indicates these people are. And start at the top!

         This ain’t rocket surgery and unlike the Trump Administration, we already know these guys can’t shoot straight. Why pay them so much? “Put ‘em on commission,” as Jackie Mason said of Congress.

         The best way to close any budget gap is to spend less. It works for households, governments, and businesses. It will work for MD Anderson, but let’s not blame those who have done nothing to contribute to the deficit.

         The morale will not improve with blame.

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