I would like to take this opportunity to clarify my understanding of the current hospital situation and the framework within which my decision making occurs:

andbull; Seaside Hospital; 1972-87; nurse's aide, LVN (C/R Del Norte, 1977-78), respiratory therapy technician, registered respiratory therapist, Cardio-Pulmonary Department manager.

andbull; Breatheasy Inc.; 1985-95; employee-owned, full-service home medical equipment business; founded, operated and sold to Apria.

andbull; Del Norte County Board of Supervisors; 1991-94; proudly represented District 3.

andbull; Past chairman, Del Norte Solid Waste Management Authority; 15-plus years, Solid Waste Task Force.

andbull; Local Mental Health Board member; 1991-present.

andbull; Community Health Alliance of Humboldt/Del Norte; 1995-2012; regional consortium exploring more effective approaches to health-care delivery in rural/remote locations.

andbull; Del Norte Healthcare District; 1996-present.

andbull; Resource Advisory Committee.

andbull; Hub member, Building Healthy Communities

andbull; Numerous advisory committees, study groups, etc., exploring more inclusive/affordable health-care systems in rural/remote locations.

andbull; Resident of DN since 1969; married (Beth) for 36 years; living off the grid on South Fork Road since 1975.

Significant change is coming to our local health-care delivery system. We have more opportunity now to help shape our health-care future than ever before. We will not get there by debating, but by discussing; acknowledging not accusing; collaborating not condemning. This is not a Them vs. Us battle.

The past health-care system is broken and non-repairable; the Affordable Care Act is the new health-care reality. We should spend our energies implementing ACA, not yelling at and demonizing those who we disagree with.

"You don't need a weatherman to know which way the wind blows" - Bob Dylan

As to the Strategic Options Study: My involvement as a private citizen was known by the Healthcare District Board from the beginning and did not begin until after the settlement agreement was reached; at no time did I represent myself as a HCD director; had the HCD accepted a seat at the table, my choice would have been Terry McNamara.

I'm with whatever supervisor said it was stupid not to participate in the study - most study group participants were skeptical, a couple were openly cynical; all questions asked were answered; all meetings were open to the chief of staff; conclusions reached were by consensus.

Physician recruitment/retention is extremely difficult here, private practices are disappearing and are being replaced by multi-specialty groups/clinics and foundations. In California, state law makes this even more difficult. The information reported by the Camden Group did nothing for me but verify, statistically, trends that have been occurring for many years.

Profiteer: One who makes excessive profits on goods in short supply - American Heritage College Dictionary.

Sutter Coast Hospital receives yearly subsidies from the state for serving all clients in their service area, regardless of their ability to pay. This state money comes from a tax levied against those hospitals that do make a profit; it is willingly paid and found unanimous support in the Legislature. Statistics used to verify need are fully audited and available to the public.

The payer mix at Sutter Coast completes the circle. With such large numbers of Medicare recipients and the newly emerging ACA insured (30-40 percent of us), providing quality care in this market will continue to be challenging. Most areas see much higher percentages of "commercial" insurance (30 percent; ours is 16 and dropping) which helps moderate the cost of care for other clients.

While in the past Medicare was looked at to "pay the bills," it is no longer relied upon to do so. Again, the statistics used are reported to the state and feds and are available to the public.

Because Sutter Coast is receiving state-subsidized payments for uncompensated or under-compensated care and the payer mix being what it is, "profiteering" is not a word I would use to describe the business of Sutter Coast Hospital.

Rural/remote hospitals can no longer rely on fee-for-service payment models to "pay the bills." Critical Access Hospital designation was created to assure financial feasibility for rural hospitals.

No matter who operates our hospital in the future, they will do so under Critical Access. Our local demographics dictate that we will be part of a larger system: any systems suitable for us are "regional," own the hospitals they operate and have local advisory boards to assist in system-wide decision-making.

Any partner we have must be willing to accept ACA. All concerned understand there is no model for rural/remote health care; we need a partner who is willing to explore with us those "models" that will work for us!

I do not condone excessive executive salaries; if we want an end to that kind of activity, single-payer, universal coverage will go a long ways toward achieving that end! It is time for us to stop bickering, implement ACA, determine what this community's health-care needs are andmove on.

There is a tremendous amount of work to do, work that only we, all of us, can do. I invite all of you to join me in that work!

Clarke Moore is a member of the Del Norte Healthcare District and recently participated as an individual in a Strategic Options Study for Sutter Coast Hospital.