More Than $1 Million to Run a Public Health Agency

After a well-publicized story that managers of small town in California were paid in the high six-figures, reporters in California have gotten interested in the pay of public officials.

Thus the San Diego Union-Tribune reported on the compensation received by CEOs of local public health agencies, called public health care districts, two of which run hospitals. One in particular received generous compensation:

The top official at Palomar Pomerado Health, a public agency serving health-care needs in Poway and Escondido, receives in excess of $1 million in compensation per year.


Michael Covert, who has run the North County hospital district since 2003, receives a base salary of $736,000 a year. Retirement, bonuses and other benefits push Covert’s total pay past $1.1 million.

One other public health CEO, also responsible for a hospital, made somewhat less:

Tri-City chief executive Larry Anderson collects a base salary of $480,000 and benefits that drive his total compensation past $625,000 a year. He also received a $50,000 relocation benefit when he arrived last year.

Two CEOs of health districts that did not run hospitals, having leased them out, made less still:

Grossmont chief executive Barry Jantz makes about $183,000 a year in base pay and benefits that increase his total compensation to just under $250,000 a year.

Fallbrook administrator Vi Dupre, ... is paid a base salary of $61,000 a year and benefits that raise her compensation to just over $69,000,....

Why is Mr Covert paid so much?

Bruce Krider, the health-care district chairman, said Covert does an excellent job managing a complex enterprise that includes two major hospitals. Covert juggles the interests of staff, physicians, patients, volunteers, board members and other stakeholders, he said.

'A million dollars sounds pretty good to anybody, but my view is, pay a lot and expect a lot,' said Krider, a management consultant who also is a former hospital executive. 'You can’t have some mediocre public servant. You need somebody that has got vision, that can see the issues that are most important and put it all together.'

So now even the managers of public health agencies have become million dollar babies. And of course, according to the boards of trustees who are supposed to supervise them, they all do excellent work and therefore are underpaid even then. As we have noted before, it seems that every board supervising every health care executive thinks their executives are above average, if not stellar. Note, though, that the chair of the board overseeing Mr Covert is himself a retired hospital administrator. So, as we have noted before, it seems that the boards of such organizations often have a preponderance of members who are not inclined to be critical of their hired executives, much less limit their pay.

So the rules for top leaders of health care organizations seem to be different from those for you and me.  All these managers seem to be entitled to be above average.  (The only ones who are eventually deemed below average seem to be those up to no good in ways that do not financially benefit their organizations, e.g., see this.)

In my humble opinion, it is unseemly for the leader of a government run public health organization to make so much. 

True health care reform would decrease perverse incentives throughout the systems, spread the power in organizations more broadly, and make leaders accountable.

Post Title → More Than $1 Million to Run a Public Health Agency

New York City Public Health Proposes Gathering Data on All Diabetic Patients Without Their Consent

From the Associated Press, how the New York City Department of Health proposes to collect data on individual diabetic patients' control (assessed by hemoglobin A1C). "The plan would require medical labs to report to the city the results of a certain type of test that indicates how well individual patients are controlling their diabetes." "By pinpointing problem patients, then intervening in their care, [City Health Commissioner Thomas] Frieden said the city can improve thousands of lives." "The city's program wouldn't initially get patients' consent to collect data, but allow them to opt out later." "Doctors could receive letters, telling them whether their patients have been getting adequate care."
Frieden justified the program thus, "There will be some people who will say, 'what business of the government is to know that my diabetes is not in control?'" "The answer, he said, is that diabetes costs an estimated $5 billion a year to treat in New York and was the fourth leading cause of death in the city in 2003, killing 1,891 people." Frieden concluded, "I don't think we can afford not to do anything."
Dr. Paul Simon of Los Angeles' public health agreed, "Some people are uncomfortable with public-health departments expanding their scope beyond infectious disease, but I would say we have to do it. Chronic disease accounts for the major portion of life lost to illness, these days."
Hold the phone, here. Because diabetes is a severe and costly chronic disease, a local government feels it has the justification to collect individual patient data, without the patients' consent, and then intervene directly in their care? We are on a real slippery slope here, since this justification could be used to intervene on nearly any aspect of medical care, or of private behavior for that matter.
In the past, public health has involved some uncomfortable trade-offs between protecting the population from disease and individual rights. However, most of those diseases were infectious or toxic, and the measures involved protecting people from exposure. But using chronic disease as a justification for the government assuming this degree of control of medicine and of individual's behavior would involve breath-taking trade-offs.
Health Care Renewal quiz time: what nation in the 1930s was known for the unprecedented vigor of its anti-smoking campaign? Hint, an article in the British Medical Journal in 1996 featured a poster with this testimonial, x "drinks no alcohol and does not smoke.... His performance at work is incredible." [For the answer, go here.]
For the tip, thanks to MedPundit.

Post Title → New York City Public Health Proposes Gathering Data on All Diabetic Patients Without Their Consent