The Flake misleads on Dr. Carmona’s record

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Posted by AzBlueMeanie:

So have you seen the latest attack ad from The Flake against Dr. Richard Carmona with the tagline "another Obama big spender"? That's pretty rich coming from this guy.

Before I address the ad, let's look at The Flake's voting record on major legislation. Representative Jeff Flake – Voting Records – Project Vote Smart (this is the record of an ideologue).

BushTaxCuts_deficit_85pThe drivers of our national debt since 2001, when President Clinton was running budget surpluses and the national debt was projected to be paid off in full by the end of the decade, are: the Bush tax cuts in 2001 and 2003; the war in Afghanistan and the unnecessary war in Iraq that were put on the nation's credit card; the unfunded Medicare Part D prescription drug subsidy to Big Pharma; and the Bush Great Recession in 2008 which led to the TARP bailout of the financial system and a recovery package to prevent the country from spiraling into a Great Depression.

So how did The Flake vote on these measures?

The Flake voted for the Bush tax cuts in 2001 and 2003 without paying for them. He voted for every tax cut measure under Republican control of the House (2001-2006). He proved that he is an ideologue by voting against tax cut measures contained in recovery bills proposed by the Obama administration under Democratic control of the House.

The Flake voted for the Authorization of Use of Force against "terrorist organizations," i.e., the war in Afghanistan, and the unnecessary war in Iraq. These wars were put on the nation's credit card and paid for with borrowed money that added to the national debt.

The Flake had an interesting game he played with runaway "borrow and spend" budgets during the Bush years. He voted for Republican House budget resolutions, which is the framework of the budget, but routinely voted against the separate appropriations bills that actually funded the government (so he could maintain his street cred as being against government spending). The appropriations bills The Flake did vote in favor of were for the Department of Defense. The Flake had a mixed record on those Supplemental Appropriations for the wars that the Bush adminsitation used to keep war spending off budget. The Flake voted against these Supplemental Appropriations beginning in 2006.

Causes of National DeficitThe Flake did vote against the Medicare Part D prescription drug subsidy to Big Pharma. He does not get a pass, however. He subsequently voted against bills which would have permitted Medicare to negotiate for lower rates and to import prescription drugs to lower costs to consumers. He did nothing to control the cost of this subsidy to Big Pharma.

When the economy blew up in 2008 as a result of casino capitalism by the banksters of Wall Street and failed GOP economic policies, The Flake voted to do nothing.

That's right, The Flake would have let the financial system collapse and take the economy down with it in a death spiral of a Great Depression. The Flake voted against every recovery measure and voted against unemployment benefits for the millions of Americans thrown out of work as a result of failed GOP economic policies. If you think the past four years have been difficult, imagine the economic hellscape it would have been had The Flake and his ideological extremist pals gotten their way.

Given his record in adding to the national debt with the Bush tax cuts and two wars on the nation's credit card, The Flake is in no position to criticize his opponent, who has never served in elective office.

Here is the Dr. Richard Carmona for U.S. Senate campaign response to The Flake's attack ad:

Carmona campaign responds to Congressman Flake's negative ad
Career politician misleading Arizonans

Career politician and former lobbyist Jeff Flake today launched a misleading attack ad on Dr. Richard Carmona's term as director of Kino Community Hospital, a public hospital responsible for providing indigent care. 

What Congressman Flake's ad doesn't say is that Kino Community Hospital was required by law to cover all patients — including those without the ability to pay. As the cost of providing care continued to rise, the state, federal and local funds for that care did not.

Dr. Carmona repeatedly raised these budgetary issues with the Pima County Board of Supervisors. The Board of Supervisors insisted that Dr. Carmona and Kino Community Hospital continue to provide indigent care without the funding to do so. Dr. Carmona also pushed the board to do more to reduce cost throughout the health system.

Following his departure, the hospital continued to lose money and the board eventually adopted several of Dr. Carmona's recommendations. Many of the then-board members — including Republicans — credited Dr. Carmona for fighting to make needed changes to the hospital.

"Congressman Flake is desperate and doing what a career politician and former lobbyist does, intentionally misleading the voters," said Carmona for Arizona Communications Director Andy Barr. "Dr. Carmona was responsible for running an enormously complicated health system that provided care to a low income area and many people without health insurance. Dr. Carmona implored the Pima County Board of Supervisors to make necessary changes, some of which they later made. This issue came up during Dr. Carmona's Senate confirmation process to become the 17th Surgeon General of the United States, and he was confirmed unanimously."

BACKGROUND: 
CARMONA WARNED THAT COUNTY OFFICIALS WOULD HAVE TO FACE REALITY OF DECLINING FUNDS AND INCREASED DEMAND FOR CARE
Carmona: Board Of Supervisors “Will Have To Face” Decrease In Federal And State Funds For Uninsured. In 1996, the Tucson Citizen reported that Carmona was sounding the alarm on the high cost of maintaining the health system.  “As health care dollars shrink, Kino Community Hospital’s chief executive officer, Richard Carmona, says it’s a good thing the hospital received extra money this month from the federal government…’This helps us to catch up with some of the deficit we have,’ Carmona said. ‘But the reality is that more and more patients are coming through our door for care, and this money will only help to offset our losses.’…But Carmona said he doubts Kino Hospital will get extra money in the future. He expects the amount the hospital now receives will decrease. And as the federal and state dollars for the uninsured decrease, more responsibility will fall to the county, he said. ‘Ultimately, someone has to accept responsibility for these people. These health policy issues are something the county Board of Supervisors and the community will have to face,’ Carmona said.” [Tucson Citizen, September 30th, 1996]

County Board of Supervisors Mandated Kino Continue To Provide Indigent Care, Lifted Freeze On New Clients. In January of 1998, the Board of Supervisors “lifted its month-old freeze on accepting new clients for indigent health care and domestic services, and ordered its health director to find a way to pick up the tab without going over budget.   The Board of Supervisors voted unanimously yesterday to have Dr. Richard Carmona, chief executive officer of county health programs, keep providing medical care to the county's 2,300 clients and to honor existing contracts with 24 agencies providing services for the county. He also was ordered to resume adding clients from the waiting list.”  Simultaneously, the Board ordered Carmona to “implement a cost-cutting plan so that the county could cover a $1.06 million anticipated deficit at the end of the fiscal year June 30.” [Arizona Daily Star, 1/14/98] 

KINO’S DEBT WAS DRIVEN BY HIGH COST OF INDIGENT CARE, LACK OF STATE FUNDING
Carmona: Kino “At A Disadvantage” Because Of The Population It Serves. Respond to a question about layoffs, Carmona said Kino “is at a disadvantage,” compared to other hospitals.  He pointed out that Kino served “a population that is generally sicker than average, has no place else to go because of financial considerations and has language barriers and transportation problems to overcome.” The Daily Star noted that Kino is the “only safety net for patients who can't afford health care but aren't eligible for state help,” and is also responsible for providing “indigent care for the Arizona Health Care Cost Containment System.” [Arizona Daily Star, July 8, 1999]

Uncompensated Care Was “Greater At Kino Than Other Tucson Hospitals." In Pima County, hospitals are hard hit by mandated services for which they rarely recoup costs from illegal aliens who can't or won't pay, committee members were told. Reductions in federal and state funding, combined with increases in both legal and illegal aliens, and a host of other "external forces" affect both staffing and operating costs, said Scott Floden, Kino Community Hospital's chief operating officer. "Uncompensated care is greater at Kino, as a proportion of payer mix, than other Tucson hospitals," he said. [Tucson Citizen, 11/2/2001]

Cap On Indigent Patients Was “Slow Strangulation” For Kino. In 1997 and 1998, KinoCommunity Hospital could not accept new indigent-care patients through the state’s Arizona Health Care Cost Containment System (AHCCCS). County Administrator Chuck Huckelberry “blamed the AHCCCS cap for much of the hospital’s $40 million deficit, calling it ‘the slow strangulation’ of Kino’s patient loads.” Because of earlier problems, the county has been forbidden by the state to accept new AHCCCS patients since 1996. According to the Tucson Citizen, AHCCCS at one time accounted for “more than $21 million a year in revenue to the county.” In 1998, it returned only $13 million. [Tucson Citizen, June 14th, 1999]

CARMONA PUSHED BOARD TO DO MORE TO ASSIST WITH HEALTH SYSTEM DEBT (1998)
Carmona Pushed Board of Supervisors To Assume Hospitals Debt. “For the second time in two months, the Pima County Board of Supervisors has postponed a decision on whether to assume responsibility for Kino Community Hospital’s $16 million debt. […] The alternative would be for Kino to find a way to repay the money it borrowed from the county’s development services and wastewater management departments 15 years ago in order to keep the hospital running. Dr. Richard Carmona, chief executive officer of the county’s Integrated Health System, first asked the board in April to take over Kino’s debt. Yesterday he repeated his request, asserting that the board and not the hospital is responsible for the debt. ‘All it is, is a fund transfer approved by the board to keep their policy going,’ Carmona said.” [Tucson Citizen, 5/27/98]

AFTER CARMONA LEFT, HIS RECOMMENDATIONS WERE PUT INTO EFFECT IN AN ATTEMPT TO BALANCE KINO’S BUDGET
Hospital Budget Balanced Through Cuts To Services, County Subsidy. In 2000, after Carmona left, the Board of Supervisors cut some services and provided a $3 million subsidy toKino Hospital, a move Carmona had recommended.   [AP, 3/28/2000]

Health Care Commission Disbanded  In 2000, As Carmona Had Requested In 1999. In 2000, the Board of Supervisors disbanded the Health Care Commission, as Carmona had recommended in 1999. [Tucson Citizen, 7/2/99, AP, 2/3/2000]

BY 2002, KINO WAS STILL LOSING MONEY BECAUSE – AS CARMONA POINTED OUT – IT REMAINED THE HOSPITAL OF LAST RESORT AND WAS INSUFFICIENTLY FUNDED
County Proposed Shuttering Kino Community Hospital Because It Was Still Losing Money In 2002. In 2002, the Board of Supervisors considered a proposal to “pull the plug on inpatient medical and surgical services at Kino Community Hospital” as the hospital was still losing money – an expected $15 million FY2003-2004.  However, critics objected to the closure, saying that “federal law will still make the county responsible for mandated medical care” no matter what facility is used.  The Citizen reported in 2002 that Kino “lost about $70 million over the past decade, much of it from providing mandated care to poor, uninsured patients. A report by a consultant several years ago also blamed the hospital's failure to collect millions over the years for care it provided that should have come from state and federal medical reimbursement programs.” [Tucson Citizen, 12/12/02]

IN 2002, MANY OF THOSE CLOSE TO THE SITUATION PRAISED CARMONA’S TENURE
Republicans Ray Carroll And Mike Boyd Backed Carmona. County Commission Republicans Ray Carroll and Mike Boyd backed Carmona when the Board considered whether or not to fire him. Boyd called Carmona “a scapegoat for the woefully inadequate leadership by the board and the health care commission.” Boyd said “The board didn't have the guts to make the budget decisions they should have made, so the want to fire the director instead.”  Carroll also “said he believes Carmona has been forced to react to political pressures instead of being left alone to run the hospital and health care system.” [Arizona Daily Star, July 10, 1999]

Carroll: Carmona Was “A Messenger Who Was Punished For Delivering An Unpopular Message.” The Tucson Citizen reported that Ray Carroll, the lone supervisor to vote against Carmona’s resignation in 1999, said “He inherited a system that was leaking for years,” calling Carmona a messenger who was punished for delivering an unpopular message. “He was telling the board things some members didn’t want to hear,” Carroll said. “He was embattled after that. I think he was treated very badly.” Carmona “will make a great surgeon general,” Carroll said.  [Tucson Citizen, 3/28/2002]

Former Kino Board Chair: “I Think Those Who Look At It Critically Would Say He Did A Good Job…The Problems Existed Before He Entered The System.” Carmona quit at a time when Tucson's Kino Community Hospital was facing mounting financial difficulties. At the time, Carmona was criticized for not keeping officials apprised of the hospital's problems, while Carmona's defenders say not all the difficulties can be laid at his feet.  "I think those who look at it critically would say he did a good job," said Mike Rollins, former chairman of the hospital board. "The problems existed before he entered the system." For his part, Carmona said he had been planning to quit the health director's post for some time and in no way felt pressured to leave. "It got to the point where I didn't feel I could be as productive as I wanted to and it was time for someone else to give it a try," he said. "There were no hard feelings." [LA Times, 3/29/02]

Rep. Grijalva: “What Happened At Kino Cannot All Be Laid At His Feet.” Carmona took over Pima County's financially troubled Kino Community Hospital in 1995 and was promoted to run the county's entire health care system two years later. But he was forced to resign from that post in 1999 after the hospital's problems continued to mount. "What happened at Kinocannot all be laid at his feet," said former Pima County Supervisor Raul Grijalva, who helped engineer both Carmona's hiring and his ouster. "It became more of a political decision because what was at stake was the survival of the hospital. That became the driving thing." [Arizona Daily Star, 3/27/02]

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AZ BlueMeanie
The Blue Meanie is an Arizona citizen who wishes, for professional reasons, to remain anonymous when blogging about politics. Armed with a deep knowledge of the law, politics and public policy, as well as pen filled with all the colors stolen from Pepperland, the Blue Meanie’s mission is to pursue and prosecute the hypocrites, liars, and fools of politics and the media – which, in practical terms, is nearly all of them. Don’t even try to unmask him or he’ll seal you in a music-proof bubble and rendition you to Pepperland for a good face-stomping. Read blog posts by the infamous and prolific AZ Blue Meanie here.