New Britain General Hospital was the eighth-largest employer in town two decades ago. Now it’s number one. That may sound like good news, but it’s not, says hospital President and CEO Laurence A. Tanner, M.P.H. ’72.

His hospital now ranks as top employer because the city’s seven largest manufacturers all left town, went under or reduced their work force. Tanner has long experience with how that kind of economic pressure affects health care: since studying hospital administration under John Thompson at Yale in the early 1970s, he has served three decades as a hospital administrator, working for 15 years at two other Connecticut hospitals before joining New Britain General as its president in 1987. Now Tanner foresees “chaos” as local economic pressures combine with cuts in government funding and the end of the “Robin Hood theory of health care.”

The struggle to survive financially overshadows all other concerns for Tanner as he runs the Central Connecticut Health Alliance, which employs 3,000 people and comprises three hospitals, two nursing homes, two assisted-living facilities and a mental health center with several locations. Two-thirds of New Britain General’s income comes from “inadequate and drastically shrinking” state and federal funds. Last spring, Connecticut was paying only 50 cents per dollar of costs for Medicaid, while the federal government paid 90 to 94 cents per dollar for Medicare. Insurance companies no longer bridge those gaps through higher fees paid by insured patients. “Industry has said they can’t afford it,” says Tanner. The problem is compounded by the expectation of patients that they will have access to the latest diagnostic technologies and therapies, regardless of cost.

New Britain General has controlled costs by restricting prescription formularies, postponing building repairs and joining with other hospitals to buy supplies. The hospital has also diverted funds from education and prevention into the operating budget. “We think we’re doing a disservice from a public health perspective, but we have a financial imperative,” says Tanner. “I have the day-to-day dilemma of how to provide care for the person in the hospital today.” Tanner worries that recent medical advances and those on the horizon will be denied to patients who can’t pay. For instance, a cardiac defibrillator like Vice President Dick Cheney’s costs $30,000 to buy and implant. Medicare reim-burses less than $20,000. So who gets to have one?

Tanner’s strategy for improving financing long term is to talk to policy-makers. He occasionally visits the Connecticut Legislature and has twice addressed the federal House Ways and Means Committee. His goal is to help lawmakers understand the impact of cuts in funding, of new regulations and of the nursing shortage—“informing the decision makers on the consequences of acting or failing to act.”

In fact, the nation’s decision-maker-in-chief visited New Britain General on June 12. President George W. Bush chose Tanner’s hospital as the venue for a speech on Medicare reform and prescription benefits. The president addressed 250 people in the hospital cafeteria en route to Maine to celebrate his father’s birthday. Although Tanner did not get to buttonhole Bush to convey his own policy proposals, he found the visit satisfying. “It tied public policy to a real hospital.”

The region’s bad economy has touched Tanner personally: his wife, Janice Ann Piazza, recently lost her job as a manufacturer’s website developer. “She was outsourced and downsized,” he says wryly.

When he feels overwhelmed, Tanner visits the neonatal icu. There he likes to watch the premature babies “and see them thrive.” Visiting the newborns provides an antidote to the “daunting process” of running a hospital with shrinking resources. “It’s a frustrating process and in some cases a depressing process,” says Tanner. “In some ways it’s also an invigorating process. When you have a small victory, it’s a victory. You know that what you’re doing is benefiting people. There’s somebody out there who’s getting a service that they wouldn’t otherwise get.”