Miami-Dade County’s Jackson Memorial Hospital is Adrift in a Sea of Incompetent Executive Management
The utter contempt that Jackson Memorial Hospital’s managing board, the Public Health Trust, and the Miami-Dade County Commission, have displayed for the residents of Miami-Dade County and the Jackson health system has reached a new high.
The Miami Herald reports, here, that the treasurer of Jackson Health System’s governing board noted this week that cash is getting “dangerously low” and that major cost cuts may be needed. Currently, Jackson will likely end the month of January with only 16.7 days of cash on hand. Hospital’s median day’s cash on hand is closer to 90 days cash, making Jackson’s days cash on hand ratio abysmal, and a true operating emergency.
Additionally, Jackson experienced a 7 percent drop in patient revenue, a material and significant decrease to any business entity. The impact on Jackson, though, is pronounced, given its already weakened financial condition and its primary mission of serving the uninsured.
Jackson’s real problems are the result of institutional ignorance and complacency. This author was briefly involved in the nomination process to sit on the Public Health Trust, and met with a panel of Miami-Dade County commissioners, Florida legislators, Public Health Trust members, and other important local politicians.
A 3 hour panel discussion ensued regarding Jackson’s status, and it became painfully obvious that the current Public Health Trust Board and the Miami-Dade County Commission are truly ignorant of the financial status of the hospital. This author reviewed over 1000 pages of material in preparation for the discussion, much of it dense financial data. It quickly became apparent that most of the people sitting on that panel had little knowledge of the contents.
The questions posed to this author were mostly superficial and chosen to deflect attention from the institutional incompetency that has seized Jackson for much of the last 2 decades. The issues being confronted by Jackson were merely magnified by the current economic crisis, but were certainly not caused by it.
The author reviewed a “stop-gap” financial proposal to immediately enhance revenues and reduce costs at the hospital, and noted that the nearly 100 planned initiatives should be vetted for reasonableness and predictability. Institutional initiatives aimed at closing financial shortfalls frequently fail due overeager management’s failure to account for the many inherent pitfalls.
Regrettably, the Herald notes that many of the 94 initiatives, worth $200 million in reduced costs or increased revenue, are already behind schedule. Is it any wonder, though, that the board and county commission, largely comprised of non-financial laypeople, are sufficiently competent to make complex business decisions in a vacuum? This author noted that at least 4 prospective Public Health Trust candidates had significant financial statement and business modeling experience. Of those 4 highly qualified candidates, how many were chosen: Zero.
Past boards and county commissions have largely applied super-sized Band-Aid’s when dealing with Jackson’s problems, including accounting gimmickry, financial speculation with new revenue streams, and other one-time financial gambits designed to kick the deep, structural problems to new generations, including Jackson’s onerous labor costs. Unfortunately, that day of reckoning has begun arriving. Like the leading edge of a large hurricane, the gail force winds of this impending crisis have already swamped management’s coping ability. The resulting financial hurricane could cause the residents of Miami-Dade County to feel unimaginable pain, as care will likely have to be significantly reduced to uninsured residents.
Jackson’s institutional incompetence not only impacts Miami-Dade County’s bottom line, but very difficult and highly controversial quality of care decisions are forthcoming, and none of them will likely enhance care provided to the most impoverished of this community. How such an important institution has been allowed to decay into this abyss is criminal, how no one has noticed the contempt demonstrated by its leaders is frightening.

Post-Industrial Japan’s Developing Caste and Generational Inequality are Strangling Younger Workers
In an ominous warning to other, post-industrial developed economies, Japan seems mired in an economic straitjacket decades in the making. A majority of its younger workers are unable to find permanent, regular jobs, and feel increasingly marginalized. Instead, Japan’s corporate structure is geared towards protecting its aging population and bloated pension systems.
A recent article in the New York Times, here, highlights the individual distress felt by its young workers. Amazingly, this has resulted in a “brain-drain” of highly educated Japanese to other countries and threatens to stunt economic growth for generations. This generational inequality is partly to blame for Standard & Poors recent downgrade of Japan’s sovereign debt.
Last year, nearly 45% of young workers held “irregular” jobs, akin to contract labor in the United States. These jobs offer low pay, no benefits, and no pension. Only 56.7% of university seniors received job offers in 2010, an all-time low.
The graying of Japan and its reluctance to undertake the structural changes necessary to include young adults in its economy is producing a new, “lost generation” of disenfranchised youth. These second-class citizens will endure a rapidly-declining standard of living and a widening gulf between the “castes”.
The cultural ethos prevalent in Japan encourages conformity and obedience. Japan’s economic engine thrived on this ethos and their ability to mold university graduates to the firm’s culture. This allegiance to the firm produced a robotic, nearly mechanical worker whose primary goal was the maximization of firm profits and revenue growth.
Unfortunately, this ethos is obsolete, and Japan’s near absolute reliance on this standard has stunted the growth of individualism and entrepreneurship. Japan has few initial public offerings, and Japanese entrepreneurs primarily skew older.
Japan has faced a stagnant economy for the last 20 years, which shows no sign of abating. As workers age and consume even greater resources, the failure by Japan to nourish its newest workers will eventually condemn the country to a permanent, downward spiral.
The United States and the rest of the post-industrial world should view Japan as a cautionary tale. Although the United States and Japan are dissimilar in many respects, both have aging populations that are consuming greater resources with every passing year.
The United States faces a similar pension, municipal and state crisis that has only recently begun to manifest itself. The great boom of 2002-2008 merely masked the dire conditions of municipalities and the staggering amount of unfunded pension liability throughout both the public and private retirement systems. Similar conditions exist throughout many other post-industrial societies and economies, some better, and some worse.
Ignoring these problems will only produce much greater and more intense pain at some point in our near future.  In Japan, the need to reduce deficits will ensure that younger Japanese will never receive the level of retirement benefits currently enjoyed by retirees today. The same is true in the United States. Already, much of the private pension system in this country has been dismantled; the destruction of the public retirement system has just begun.
As a result of its booming growth throughout the 1970’s and 80’s, Japan began confronting these issues much sooner than the rest of the post-industrial world. Japan’s free-fall began in the 1990’s, a period of positive growth in the United States. That Japan has been unable to halt this economic decline throughout the last 2 decades is a chilling reminder of what may confront other post-industrial economies.
A thoughtful study and analysis of Japan’s “lost decade” might illuminate the path forward for our country, and prevent the aggressive stagnation that has taken root, like wild grass, in our own economy. A failure to understand the similarities and differences, and learn from them, would be a grave mistake indeed.

Our national, economic betrayal is merely a symptom of much larger, personal betrayal
As the current year fades and the new year begins, a trend continues to emerge in our society that is every bit as damaging as the economic fraud that has nearly plunged our country into another depression.
This fraud, which I’ve dubbed emotional deceit, is the constant betrayal of mutual trust and respect that has seeped into nearly every corner of our personal lives. The resulting emotional upheaval leaves a trail of destruction so bitter and permanent that it threatens our social and moral fabric.
What are some of the signs and symptoms of emotional deceit in society? The betrayal by Wall Street of any sense of decency, the lack of moral courage, and the demise of corporate values are all examples, and continue to shred our economy.
What occurred on Wall Street didn’t merely shock the economy into near-depression, but it ripped the veneer from the socially accepted notion that some level of decency and good-will existed between the participants in this free-market experiment. It doesn’t, and it never will, again.
Everyone’s on their own, adrift within their own, tiny life-boat. Our grand economic experiment now shifts from one of growth for all to a relentless search for economic survival and subsistence.
On a much deeper level, though, emotional deceit has seeped into the very fabric and essence of our personal relationships. The deep mistrust and cynicism that characterizes the economy and its participants now also pervades our personal relationships.
We’ve grown accustomed to, indeed, even accepting of personal betrayal, especially in our romantic and professional relationships. The gut-wrenching body blows that follow personal betrayal leave an indelible, yet permanent scar on the soul and psyche of both the perpetrator and the victim.
Perpetrators ultimately rationalize the betrayal as a byproduct of their insecurities and neuroses, but fail to acknowledge its real source: their overwhelming narcissism and unchecked self-absorption.
The reckless disregard, even contempt, for the broken, littered path of destruction that lies in the wake of betrayal merely reflects the emptiness of our lives. Our individual and collective inability to attach meaning to events and people that entered our lives, that were placed there to assist us through our journey through life, represents a betrayal of the soul and a repudiation of our humanity.
Having recently lived through just such an episode, I am witness to the fact that these events ultimately define the character of the participants, both the perpetrator and the victim. Each is left scarred, broken and wounded, adrift to reconstruct their lives as meaningfully as possible.
The victim will ultimately recover, mourn and seek some meaning from the experience. The perpetrator, though, becomes hardened, thickened, and more insular. The deceit further detaches them from those inner constructs that humanize them, and they become unable to identify good from bad, lover from abuser, savior from manipulator. The fraud changes the filter and prism through which they view life and others, and ultimately collapses their soul.
What occurred on Wall Street was a systemic moral failure by collections of individuals, the same failures that occur in our personal lives. As a society, our moral compass has run adrift, guided by little more than narcissistic absorption and self-preoccupation. Is it any surprise those institutions, which are, after all, merely embodiments of our personal consciousness, should behave any differently?
Individually and collectively, we should be cognizant of the emotional wreckage that we’ve accepted in our society and into our personal relationships, and the ripples and unintended consequences occasioned by our deception, which will last very deep into our future.  Be very careful of your impact on others, but especially on those you love. The impact will last a lifetime.  Actions, once taken, can never be undone, only forgiven.