Vantage Point: The demand for dollars in a new decade

Vantage Point: The demand for dollars in a new decade

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We mark our lives by the passing of the years and so a new decade is a big event. There is a nerdy minority who insist we’re actually a year away from the twenties. They say we start counting at “one” and continue through eight, nine, and zero. But for most of us I’m sure it feels like a new decade began on Jan. 1.

The challenges we will encounter in the ’20s not surprisingly revolve around money. An immediate concern in next month’s election is the open space and parks tax, Measure K. I hope it passes, but it’s a political uncertainty; a supermajority of two-thirds is hard to achieve. And on a policy level, we can’t fund every community goal with a new tax.

If Measure K passes, St. Helena will have a sales tax rate of 8.5%, given our recent approval of a local half-cent tax. Will we keep shoving it ever higher until the sales tax reaches the nice round number of 10%?

To govern is to choose. We can’t fund every social need. At some point, we’re going to have to focus on re-carving the tax pie instead of making it bigger.

I spoke with Doug Parker, head of our local Land Trust and spokesman for the Measure K campaign. He asks us to consider a couple of things. For one, a quarter-cent state sales tax recently sunsetted, so this increase will bring us back to where we were (outside St. Helena) a couple of years ago. And he asks us to remember that this tax is “an investment in the future and the quality of life in Napa.”

I agree with him and am willing to pay more to fund our parks — I just am not sure that two-thirds of my neighbors will also agree.

Money from a federal grant as well as that local sales tax will soon pay for a more walkable downtown with new sidewalks coming next year. That may make the increased tax more palatable. I was naively unaware of the importance of navigable sidewalks until I injured my knee early this year — a non-undulating Main Street will benefit us all.

In this new decade, money is the key factor when we talk about healthcare. In that regard, I sat down with Dr. Steve Herber, president of St. Helena Hospital, to discuss where that institution is headed after the denial of its planned merger with the Queen. Herber says that while the California attorney general was considering the proposed alliance, he was constrained in commenting publicly about hospital plans. He seemed surprisingly upbeat after the merger rejection and outlined areas of planned growth for his hospital.

However, he emphasized that “I can’t subsidize” programs and departments that don’t pay their way. He is closing the inpatient psychiatric department and the maternity ward. But, he says he’s expanding outpatient mental health services and continuing outpatient women’s health services. He adds that while gynecologists at the Queen have restrictions on what they offer their patients due to religious policies, his affiliated doctors offer a full range of services for women’s health needs.

Perhaps in the arena of making lemonade from available lemons, Herber pointed out that freeing up space from the closed departments will allow him to offer more private rooms for inpatients.

One medical service he wants us to know more about is treatment of strokes. He says, “We have a relationship with UCSF neurology so we have emergency stroke care” deliverable via telecommunications. Herber says, “It’s safe as well as prudent” to come to his hospital with stroke symptoms instead of driving 25 minutes to the Queen. He also says he’s about to bring a well-regarded neurologist to St. Helena.

More broadly for the St. Helena community, Herber says he’s “exploring lots of options” including building a senior care facility on the hospital campus. This year he’s setting up a skilled nursing department, bringing in an outside contractor to run it for patients, who don’t need to be in the hospital.

That’s a theme he returned to several times – keeping us out of the hospital. He emphasized the role of his “case manager” who endeavors to keep folks at home post-hospitalization. He knows that as we age, we all want to stay at home: “aging in place.” But, he points out “there’s a gap” in our health care system for servicing and paying for that. Once again, it’s a matter of money.

Parks, sidewalks, hospitals. It’s all about the dollars. How we pay for what we want and need will define the decision-making of our new decade.

Mark G. Epstein moved to St. Helena from the East Coast early this century after a career in international relations.

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