The Public Health Trust, the governing body of the Jackson Health System, made the right decision in selecting Mr. Carlos Migoya as the new chief executive officer of Miami-Dade County’s publicly supported healthcare network.


Mr. Migoya has the experience and capability to do what Jackson desperately needs: putting its financial house in order. He brings to the job 30 years as a banker and, more recently, as Miami’s city manager, working for 10 months in 2010 without pay to clean up the city’s financial mess.  It is a sign of his genuine concern for this vital community resource that while the Trust was willing to pay him up to $975,000 a year, he settled for $590,000. That will seem a lot to the average worker but it is much less than what comparable hospital CEOs make and is less than the salary of the outgoing Jackson chief.

Good gesture

It is good that he has started the job with that gesture because he will have to inflict a lot of pain as he turns Jackson around and he will need the goodwill of all who have a stake in the healthy survival of this sick healthcare institution. The medicine, as those who work in health knows well, is likely to be bitter.

It is quite likely that some of that medicine will be doled out to Jackson employees, who have already experienced salary cuts over the past year as frantic but fruitless efforts were made to close a huge budget hole and likely will lose more pay if Florida Gov. Rick Scott’s proposal to make state employees contribute to their pensions is approved. The unions representing Jackson workers have been proving cooperative, obviously aware of the deep crisis the system faces and there is unlikely to be the need to seek to terminate labor contracts or rework them.

In any case, this is one institution where a satisfied work force is as vital to the success of its mission as is financial stability.

Fiscal year

Whatever the steps that Mr. Migoya and his administration and the Trust implement to cope with the projected $103 million budget shortfall in the current fiscal year, it must be evident by now that fundamental changes must be made in the way the system is governed if stability is to be enduring.

At the top of the list must be to make Jackson, along with its fundraising foundation, a fully autonomous institution free from the controls of the county government. The county administration must finally get out of managing Jackson and allow it to be established as a stand-alone institution. One early cause of the cash crisis facing the institution is the unfunded mandates that the county imposes on Jackson, most notoriously the requirement that it provide health care for prison inmates without providing the necessary funding. This should be easy but it can cause heartburn among those elected officials who cling to the quaint idea that they would be relinquishing some of their power.

Taxing district

The next priority is for a special taxing district to be created with its revenue dedicated solely to Jackson. That, too, will not be a novel move, since taxing districts to support public hospitals is an accepted form of revenue generation outside the fickleness of the county budget. This, too, should not be difficult. Granted, these are financially difficult times for all and asking people to pay an additional tax will not be popular – unless it is explained properly.

Revenue from a special taxing district will not be available to county leaders to divert to what they determine to be more popular projects. Taxpayers will know that the money will go towards providing them with high-quality health care.

Like the seaport, the airport and Miami Dade College, the Jackson Health System is a community jewel. It does not seem so to the critics but those who try to visualize a Miami-Dade without Jackson will quickly realize that they will be visualizing a nightmare. The current financial crisis provides the opportunity to act once and for all so that the nightmare does not materialize.