Saturday, June 25, 2022

Legacy costs

I am not a cynic. But I confess to being jaded. Still, it took my breath away when Yadkin Valley Community Hospital shut its doors in late May. Hospitals are like Waffle Houses: they’re not supposed to close, and when they do, there’s a great well of sadness that lingers longer than the failure of the average enterprise.

Of course there’s a crisis in rural health care, but for most of us, it’s just something you see on the evening news. Then, it’s back to sports or business, which are really the same thing: players getting paid too much for what are at best marginal performances.

The Yadkinville hospital’s demise is now the subject of litigation between the hospital’s owner, Yadkin County, and HMC/CAH Consolidated, the Kansas City-based company that ran the 20-bed facility. There’s a lot of back and forth about who’s to blame, but it boils down to not enough profit and not enough patients. Simply put, the residents of Yadkin County were going elsewhere for their health care needs. Now, it is unclear when or if the hospital will reopen.

The fate of the hospital got me thinking about a prank we used to pull when I worked at the Winston-Salem Journal, before the Internet ate our lunch. We would tell summer interns there had been a bad accident in Yadkinville. A train, we shouted, had jumped the tracks and hit a liquor store. The newbie would jump into action and call the authorities, only to quickly learn there was no train and no ABC store in the county. How we chuckled in our nerds’ paradise.

The tomfoolery ended in 2006, when Yadkinville voters approved the sale of beer and liquor, but there’s still no train. You can’t exactly draw a straight line between a county that misses out on the railroad, keeps up the good fight against alcohol for years, then — at least for now — loses its hospital; but on the other hand, there’s a connection of sorts. The decisions communities make — or have made for them — about development in one generation can impact the next one and the one after that. To use a railroad metaphor, sometimes you don’t know where the tracks lead until the train stops.

I once wrote about beer merchants who had stores just beyond the Yadkin County line, selling six-packs to folks on the way home. It was a lesson in economics, not morality. Consumers want what they want — whether it’s beer or medical services — and they really don’t care about borders.

But governments do. Deeply. Their first order of business is to build a fence. The debate I’ve been following most closely at the General Assembly this year involves whether to change the way the local sales tax is distributed — in essence, to lower the fence. Right now, it’s largely done at the point of sale. If you live in Stokes County and buy a grill at Wal-Mart in northern Forsyth County, the local portion of the sales tax mostly stays in Forsyth. And conversely, when Wal-Mart finally builds a supercenter in Stokes, which should happen next year, the county expects an extra $1 million in sales-tax revenue. These won’t really be new dollars. They’ll just move across the county line.

You could call this the Little Red Hen theory of tax collection: I built the store, so I get to keep the taxes. It is a reasonable, somewhat market-oriented approach. On the other hand, if you are on the giving end of the tax pipeline, the whole concept can seem pretty condescending, just one more slap for not having the sufficient demographics to support a Dick’s Sporting Goods or Best Buy.

Republican legislators in the N.C. Senate want to change the formula and apportion more of the sales-tax proceeds based on where people live rather than where they shop. Proponents call this approach fairness. Opponents, including Gov. Pat McCrory, call it “redistribution,” a criticism usually reserved for the most egregious excesses of the welfare state.

In truth, there is some fairness involved with finding a new way to spread tax revenue around. But whatever good intentions exist are laced with a too-generous dose of spite: It’s no coincidence that most of the sales-tax losers under this plan are the big metro areas, places where Democrats still wield power.

We are an often contradictory species, equally capable of performing extraordinary acts of kindness and of pettiness, and of finding intellectual legitimacy to whatever position best suits our needs. For me, this debate over how to divvy up the sales tax is flimsy Sheetrock dope covering up the deep crack in our living-room wall.

It obscures the bigger problem: We still haven’t figured out how to bring prosperity — which is really self-determination — to all corners of our state. The hospital in Yadkinville isn’t the canary. It’s the coal mine, and whatever remedies exist won’t be found in politics as usual, with simply punishing one group at the expense of another. They’re found in policy, the long, hard slog of concerted effort and bipartisan cooperation. Until then, we’ll continue to vote with our feet and our gas pedals.


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Ken Otterbourg
Ken Otterbourg is a writer who lives in Winston-Salem.

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