Austin @ Large: Bulletproofing Betty
'Public Safety' opens up to include Dunkerley's health care plans
Despite her grandmotherly air, Betty Dunkerley describes herself as a "tough lady." But is she tough enough to defend Austin's safety and security? Well, it appears she already has.
Or so we can infer from the final report of the mayor's Public Safety Task Force, chaired by Council Member (and 18-year APD veteran) Danny Thomas, which hit the streets this week. Usually, when we think "public safety," we think police, fire, EMS, people in uniforms with badges (and sometimes guns). We especially think that now, with even li'l old Austin fretting over "homeland security," with federal agents taking over the airport, Camp Mabry surrounded by barbed wire, and talk of one war after another after another. At least that was the context when Mayor Gus Garcia appointed the task force six months ago.
But the PSTF -- which, in both its meetings and its report, set a tone of clear-eyed diligence that deserves some commendation in itself -- ended up offering its most dramatic advice not about "public safety" in the clichéd men-with-badges sense, but rather about public health. Of course, the public health system is part of this homeland-security deal, and EMS is about health as much as "safety," so it's not like the PSTF strayed into someone else's turf.
Well, not entirely. The PSTF did consider public health in the homeland-security sense -- the capacity of Austin's public clinics and hospitals to deal with anthrax or plague or thousands of civilian casualties -- and the report recommends that the city develop a better contingency plan for handling the unthinkable. But the task force went further, calling on the city to build an urgent-care clinic at Brackenridge to take the heat off the overcrowded emergency room and finding that Austin needs to "stabilize the health care financing base." While the PSTF stopped short of endorsing a stand-alone health care taxing district, it came pretty darn close.
And so the city's public safety agenda, and the citizen leaders who advocate for it so strongly, have fallen squarely in line behind Betty Dunkerley, who campaigned on exactly this issue with exactly these proposals. Obviously, since Dunkerley came to office from the other side of City Hall, she brought with her a sense of what city staff wants, and the PSTF took seriously its injunction to provide input that city staff could use and use now. So everyone was already, if not on the same page, at least in the same chapter. That the task force embraced Dunkerley's health care program -- the issue, she has said, that motivated her to run for City Council in the first place -- is nonetheless a small but significant triumph.
Betty's Bona Fides
As expected, Dunkerley -- the city's former chief financial officer, and then an assistant city manager whose portfolio included public health -- has already seen her campaign priorities translated into budget proposals. The FY2003 budget currently under review includes a planning study for the "24-7" urgent-care clinic, as well as a designated "public health reserve" of $33 million -- enough to fund the city's clinics for three years if the current state-federal funding scheme that helps underwrite indigent care (the "disproportionate share" revenue, usually known simply as "dispro") goes away. The $33 million (more, actually) is already in the Hospital Fund, but nothing currently restricts how it can be spent, and previous City Hall regimes would have eyed it longingly in the face of a $75 million budget shortfall.
That both City Manager Toby Futrell and Dunkerley's six council colleagues are willing to lock that money up is a reflection of Dunkerley's influence on both sides of City Hall, particularly on this issue. (Among her storied feats of wizardry as city CFO was finding a way to use the hospital's dispro funds -- and the lease payments from Seton to operate it -- to support the clinics.) But they are still small gestures, far short of what the public health system either really deserves or really needs. Only one city endeavor in this budget is funded as well as it should be to satisfy the demands Austinites put upon it. That is public safety.
The PSTF may differ with that assessment -- it calls for steady and sizable increases in public safety staffing, including 300 new police officers over the next four years. This, in a fiscal climate where you need divine intervention to hire new city employees, is a pretty massive request. (Other than for the new women's-services unit at Brack -- the "hospital within a hospital" -- the clinics aren't adding new staff this year, despite huge increases in patient volume.) But politically, it involves no risk at all. For good or ill, nobody is going to object, at any volume above a whisper, to putting more cops on the street -- even if it means raising taxes to do it. (Many prog-left leaders would like to see better cops on the street -- the ultimate mission of a police monitor -- but that's a different issue.)
Health Is Safety
Not so for public health, as any and every Texan can sadly realize. Conventional wisdom holds that a Central Texas health care district will fail to win voter or legislative approval if it's perceived as a cover for a tax increase. (For outlying counties who depend on Brackenridge for hospital care, and who currently pay nothing into the system, a district would obviously mean a tax increase.) People don't like paying as much as they do for their own health care; they sure as hell don't like paying for someone else's, no matter how needy, and you can see this fact in action by, well, going to the Brack emergency room. Even Gus Garcia -- who has over the years earned a reputation for knowing the right thing to do and getting behind it, without much heed to political risk -- has been publicly pessimistic about a district's chances.
About the best thing, then, that could happen to Betty Dunkerley, if she wants to fulfill the mission of her council campaign, would be for health care to be embraced by the community as an essential element of public safety, and thus made politically bulletproof. And the PSTF has done its part to make this a reality -- one small step for a community, but one giant step for a council rookie.