Charlie Shields, CEO, Truman Medical Centers

KANSAS CITY, Mo.—The future of Truman Medical Centers, a two-hospital safety-net system here, depends on the state legislature—and no one understands that better than its new chief executive, Charlie Shields.

Mr. Shields, a genial 55-year-old, spent 20 years as a Republican lawmaker, ending up as the leader of the Missouri Senate before term limits forced him to step down. In 2010, he became chief operating officer of one of Truman’s hospitals, and in July he succeeded longtime Truman CEO John W. Bluford III.

Now Mr. Shields, whose office décor includes a collection of elephant statues, must press the legislature’s current Republican leaders to accept the Affordable Care Act’s expansion of Medicaid, the federal-state insurance for low-income people. Expanded Medicaid would be a financial lifeline for Truman, which is losing money as it cares for a large population of uninsured patients.

Mr. Shields said he tells lawmakers he understands their situation: “I’ve been in your shoes. I’ve made these tough decisions.” Indeed, he voted for a major retrenchment of Missouri’s Medicaid program in 2005, when about 100,000 people were cut from the rolls. He said the move was difficult but necessary amid a budget crunch, and that he always aimed for it to be reversed when there was funding to do so.

Today, Mr. Shields argues, with federal money available because of the health law, the expansion makes sense. Under the law, the U.S. is supposed to pay the full cost of Medicaid expansion through 2016, and then a share that will phase down to 90% in 2020 and beyond.

Still, he acknowledged the political challenge for Republicans who don’t want to be seen as endorsing a law that is unpopular with many constituents. In polling performed by the Kaiser Family Foundation between January and October of this year, 34% of Missouri residents favored the law, while 52% viewed it unfavorably.

As a middle ground, Mr. Shields said, lawmakers could craft a “Missouri-specific solution” that could potentially occur under a federal waiver, and “there are a lot of things that would work” as a structure for expanding coverage.

You can read the rest of the column at the WSJ website.

Perhaps what Mr. Shields needs to do is to explore something different, something Jackson County progressives would never consider. He has a reasonably conservative history during his time in the Missouri Legislature. With that history, he may be open to something radical like—privatizing the Truman Medical System, privatize both hospitals.

If the county is unable to manage these two hospitals and keep them in the black, perhaps it is time to pass them on to an organization who can. There are numerous hospitals and hospital organizations across the country who are privately owned and not only stay in the black, but actually make a (horrors!) profit.

When a CEO in a business can’t make his company profitable, the stake-holders have two choices, get rid of the CEO and hire one who can succeed, or close the doors. That truism holds true for publicly owned institutions as well.

The progressive’s solution is more taxpayer money in the form of expanded medicaid included in Obamacare. Missouri has rejected both realizing that within a few years, if that, it would be the state would who be picking up the tab for the increased expenditures of medicaid—money the state does not have unless something else is cut equally. Stealing from Peter to pay Paul is not a viable solution for Missouri.

Government, like all of us, must learn that the public money-well is not bottomless.