Nassau University Medical Center in East Meadow, NY.

Nassau University Medical Center in East Meadow, NY. Credit: Newsday/J. Conrad Williams Jr.

Oh, the drama.

That's been plentiful at Nassau University Medical Center over the past few weeks.

But let's look back farther — a heck of a lot farther, than that.

Nassau County established its public hospital in 1935, the year Elvis Presley was born.

And the 19-story building the facility now occupies opened its doors in 1974, the year Stephen King's first novel was published.

A lot has happened in the health care field since the '70s

There was no Affordable Care Act, which extended health care insurance to many who once were uninsured.

There was no "Doc in the Box" retail to draw customers who once may have relied solely on primary care physicians, or emergency rooms, for treatment of worrisome but non-life-threatening issues.

And there were no major hospital systems, which over the years have taken over what once had been unaffiliated community hospitals.

Since then, however, there have been multiple attempts to transform Nassau's public hospital into an institution that could become more competitive with community hospitals.

Part of that effort included a name change — from Nassau County Medical Center, to Nassau University Medical Center — along with adding and updating facilities, such as a state-of-the-art burn treatment unit and a maternity ward.

Through it all, staff at the hospital — and at an affiliated nursing home and community health centers — have been responsible for all that is associated with patient care.

But what is NUMC's role now, in 2020, given the changed landscape of health care?

Where does the county's public hospital fit in?

That, unfortunately, is a question overshadowed by political machinations, power plays, revolving leadership and rhetoric.

There also was one heck of a chaotic meeting after the resignation of former board chairman George Tsunis.

All of which is pitting NUMC as it is, against NUMC as it could be.

The issue isn't money.

Because money — or, more precisely, the lack of it — has been a constant, particularly since Nassau in the 1990s shoved the hospital, nursing home and neighborhood clinics off to a public benefit corporation — while at the same time burdening the corporation with crushing debt.

Public, or so-called safety net hospitals such as NUMC, are at a financial disadvantage compared with other institutions because the cost of caring for Medicare and Medicaid patients exceeds what the hospital gets back in reimbursements.

And because the hospital, again by comparison, gets fewer private insurance patients, NUMC doesn't generate volume enough to negotiate higher reimbursement rates from insurance companies.

The solution lies with more funding or fewer services — or some combination of the two, according to experts.

Nassau County stopped funding NUMC years ago.

New York State — and even other hospitals that rely on NUMC's operations — potentially could bolster NUMC's fortunes.

But the prospect is unlikely as long as there's more drama than leadership, and more chaos than transparent vetting of any potential recovery plan.

Should NUMC's decades-old building be replaced with a new one?

Should some services offered by the hospital be shed, and others enhanced?

Should the A. Holly Patterson nursing home — which now sits smack dab in the middle of the hospital campus between two new multifamily housing projects — be shuttered, or turned over to a private operator, though perhaps with a succession clause to protect union workers?

Such scenarios have been discussed, and debated, for years.

And it is likely they'll come to the forefront once more.

As they should.

At this point, there is no leaving NUMC as is.

An audit released last year by a consulting firm expressed concern about NUMC's ability to continue operating as "going concern."

In plainspeak, that means the hospital is in trouble — and for realz this time.

Which is why the Nassau Interim Finance Authority decided to step in to monitor finances, and to hire a turnaround expert.

Meanwhile, Laura Curran, Nassau's county executive, has as county executives before her begun putting her own people in place on the board of NuHealth, the public benefit corporation, which runs the hospital.

The union representing NuHealth workers is, understandably, raising alarm bells about the hospital's future.

And, significantly, the future of a partnership between NuHealth and Northwell Health could be in peril, even as the search for a new corporation CEO is back at square one.

Curran, a Democrat, said in an interview she was committed to seeing that the hospital remain viable.

"I do believe that NUMC has to be able to reinvent itself and realign itself with the changing landscape," she said.

" … How does a safety net hospital survive in a competitive landscape working on an old model? It needs to be updated," she said.

It does.

But the way to avoid fomenting more chaos and distrust, any recovery plan should be transparent.

Ultimately, NUMC will survive, one way or another.

So survival is not the issue.

It's how NUMC thrives, and how it changes to continue meeting the health care needs of Nassau residents.