“If you don’t have a seat at the table, you’re probably on the menu.”


“Most everyone is undoubtedly familiar with the term “having a seat at the table.”

Often reserved for those who are considered to have both the influence and power to make decisions and effect change, the table has become a symbol of power, negotiation and credibility through which one can forward their career, generate a sale or plot a course for enterprise success.

In other words, when one is provided with a seat at the table, it represents an opportunity to be heard and to make a difference.” (A)

When I was appointed President and CEO of Jersey City Medical Center (JCMC) in 1989, we had a Certificate of Need (CN) for a total replacement hospital on a new site but the project had stalled. I was advised to quickly develop political support for the project. The goal: to become a “player” in Trenton to have “a seat at the table”.

The strategy was to join every local board, committee and task force as a pathway for doing the same in Trenton.

So I helped form the new Hudson County Perinatal Consortium and became Chairman, and served on the Boards of the Hudson County Chamber of Commerce, the Hudson County AIDS consortium and the United Way of Hudson County. I then organized and became the first Chairman of the new Local Health Planning Board which gave me an ex-officio seat on the State Health Planning Board (Trenton!).

Early on at the SHPB a Trenton hospital applied for a CN to start open heart surgery, a proposal strongly opposed by Department of Health Staff. Since we aspired to have OHS at JCMC, this was an opportunity to set the stage for our application down the road, so under-the-radar I rounded up the votes to get the Trenton hospital CN approved. (years later we too got OHS!)

In the ways of Trenton this led to my becoming a member of Governor-elect Whitman’s health care transition team. I then served on the Governor’s Advisory Commission on Hospitals, the Task Force on Affordability and Accessibility of Health Care in New Jersey, the Governor’s Advisory Council on AIDS, and the Department of Human Services HMO-Hospital Workgroup.

When I started at JCMC, The University of Medicine and Dentistry of New Jersey (UMDNJ) had a medical education monopoly in New Jersey with three public medical schools under its umbrella. They were the only medical schools in New Jersey.

In our quest for a medical school affiliation our first stop was UMDNJ’s medical school in northern NJ, in Newark. The Dean was in favor but the relationship was vetoed by the President who was focused on developing a community hospital network which was to include all our Hudson County competitors (it never happened).

Our next stop was UMDNJ’s medical school in central NJ, in New Brunswick. The Dean was in favor, but the relationship was vetoed by the President who, we found out, had established each medical school’s “territory” and we were not in the central NJ region.

So we wound up becoming a major teaching hospital affiliate of Mount Sinai in New York City, having to overcome the UMDNJ President’s political (Trenton) efforts to stop this out-of-state relationship as a threat to his monopoly.

While working on Jersey City planning and zoning approvals for our new hospital, we ran into obstacles in one key department. Meeting after meeting the issues were not resolved. So I asked Lynn Schundler, a leader on our board, who was also the Mayor’s wife, if she would come to the next meeting for a cup of coffee. When asked what she should do at the meeting I said “enjoy the cup of coffee.” The meeting took five minutes and everything was approved.

The Board of the New Jersey Hospital Association was comprised of member hospital CEOs, and controlled by suburban hospital CEOs who wanted the state’s Charity Care funding changed from supporting safety-net hospitals like JCMC to every hospital getting its share based on charity care spending. JCMC was 75% Medicaid and Charity Care while their hospitals were 10% or less.  

Becoming Chairman of the NJHA Board was a four year project starting with Secretary, then Treasurer, then Chairman-elect, then Chairman. No safety-net hospital CEO had every made it to Chairman (and no woman CEO either). For years I did everything necessary but was never nominated to be Secretary. So some of us resigned our hospitals from NJHA and started a “renegade” safety-net hospital group. That got their attention and I negotiated our way back into NJHA with the understanding I would get the initial officer nomination. I was the first two year Secretary before becoming Treasurer, and there was a failed effort to throw me under the bus when it was my turn to be Chairman. My year as Chairman was torture but was worth the effort since it enhanced my visibility and “seat at the table” in Trenton for the rest of my career.

Since JCMC was (and still is) a safety-net hospital, we needed FHA financing (bond guarantee) to get started. Then Congressman (now Senator) Menendez was the project’s “champion.” But a glitch developed when we didn’t get FHA approval in the final days of the Clinton administration. Congressman Menendez got the approval early days in the Bush 43 administration, putting the NHP before having discussions on Cuba policy. The Menendez connection was via a senior Board member who served three governors in various capacities, and sat at many tables!

When Jim McGreevey was elected Governor (Jersey City guy, born at JCMC), I was appointed to his health care transition team at the requests of the Assembly Speaker and Senate Majority Leader, both members of our new parent board, LibertyHealth. By then we also had a member of the Assembly on each of our three hospital Boards (JCMC, Greenville Hospital, Meadowlands Hospital).  When we finally had the groundbreaking we honored Governor McGreevey, making him the honorary first newborn at the new hospital.

The New Hospital project finally got started but near the finish line we ran out of money – $5,000,000 short. Governor McGreevey provided the funding to establish the Port Authority of New York and New Jersey Trauma Center (JCMC is right near the Holland Tunnel and a stone’s throw from the Lincoln Tunnel). The key connection was again the same senior Board member.

Developing relationships with legislators is an ongoing CEO responsibility. One told me he was annoyed when a hospital CEO walked in for the first with a problem, having never previously dropped by to say hello. Fortunately I had done that! And when I once came in with three problems he said “Jon, in back of you are ten other constituents with Trenton problems. So which one of yours is most important, and if and when we resolve that, come by with the next request.”

I once asked the Senate Majority leader why his name was on a bill inimical to us. He said “Jon, sometimes I have discretion and other times I have orders from the Senate President. It’s knowing which is which that enables me to help you when appropriate”

For any request always leave a “one-pager” summarizing the topic

(One of the biggest skills a hospital CEO has is helping legislators with the health care, particularly when they or a family member need quaternary care not available nearby. But they need to consider you a friend before they will ask. My relationship with Mount Sinai in NYC paid dividends.)

I once drove an hour and a half to an 8AM Healthcare Facilities Financing Board meeting (table) in Trenton to show “respect” since it was considering an item for our new hospital project. It was the first item and took 3 minutes; we were not introduced or asked to speak. Many CEOs delegate this kind of stuff to subordinates. I never did, ever.

And it’s really important to be at legislative committee hearings and mark-up sessions (another table) when a bill that affect your hospital is on the agenda. Once it was one in the morning when some bill language was unresolved so they asked me and my CFO what to do. We were the only two people in the gallery.

“If they don’t give you a seat at the table, bring a folding chair.”  Shirley Chisholm

An area Assemblyman became Assembly Speaker in 2001. Soon after I was leading a group of hospital governmental affairs VPs from across the state and when we got to the Speaker’s office his assistant announced that the Speaker wanted to see me alone. Turned out it was about a small Hudson County matter that took one minute to discuss but we then chatted for fifteen more, and if I recall correctly mostly about baseball. I said nothing when I came out with a look of gravitas but my reputation as an “insider” was burnished.

My political credibility was further enhanced when a picture of me with President Clinton appeared on the front page of the front page of the New York Times (August 2, 1994), at a reelection rally in Liberty State Park.  Another stroke of luck where I just happened to be sitting in the first row and President Clinton sat down next to me! (Actually I was sitting in the last row of the stage when then Senator Torricelli came in with Bianca Jagger, who sat down next to me while the Senator worked the VIPs. He kept waving Bianca down a few rows at a time, and I followed. We were sitting in the front row when President Clinton came in and sat down next to me, to the dismay of area hospital CEOs who were standing in the crowd.)

In 2004, with all this political assistance we opened the new Hospital and in December of 2004 the open heart surgery/ interventional cardiology program was started only a few months before the CN expired which would have precluded another opportunity for many years, if ever.

 “If you’ve been playing poker for half an hour and you still don’t know who the patsy is, you’re the patsy.” ― Warren Buffett

When Senator Jon Corzine decide to run for Governor in 2005 after Governor McGreevey resigned, I looked for ways to become part of his “team”. First I showed up at an economic summit he held and offered one comment (long forgotten) which he used in his press briefing (long remembered). At that meeting I met his key campaign staff and started an ongoing discussion on health care policy. Soon after I was asked if they could film a health care related campaign ad at our new hospital on a Sunday afternoon. Coincidentally I happened to be there “making rounds” when Senator Corzine arrived for the shoot.

When Corzine ran into some bad news stories about his personal life, I was one of six people asked to participate in a Trenton press conference on his six position papers. One newspaper article called us “surrogates” for Corzine, another said “Attacks Dogs” for Corzine. After the polls closed I waited for Corzine’s last campaign event at the Elks Club in Hoboken for 4 hours to be there when Corzine arrived.

Sticking my neck out led to my appointment as one of four co-chairmen of Governor-elect Corzine’s health care transition team. I was often asked if I was close to Governor Corzine, since he lived in Hoboken where I live. I always said “Yup, see him all the time in Starbucks.” Rumors started that I was on the short list to be Commissioner of Health. The sitting Commissioner who wanted to stay on called me to ask about it.

On March 19th, 2004 the Newark Star Ledger had an article “Now in aisle 6: the governor, living city life -Corzine strolls streets of Hoboken.” “At Starbucks, Jonathan Metsch, wearing a baseball cap and a Hoboken sweatshirt, struck up a conversation about the Nets game the night before. Then he segued into state funding for hospitals; in addition to being Corzine’s neighbor, Metsch is CEO of LibertyHealth, which operates Jersey City Medical Center. Shamelessly lobbying, like everybody else,” Corzine joked.”

When Jon Corzine became Governor he instructed all NJ legislators on various hospital boards across the State to resign. They did.

While serving as President and CEO of LibertyHealth/ Jersey City Medical Center from 1989-2006, Jersey City Medical Center: was State designated as a Regional Perinatal Center, Level II Trauma Center, Teaching Hospital Cancer Program, a Children’s Hospital, and a Medical Coordination Center (for statewide disaster preparedness); started cardiac surgery/ interventional cardiology; and became a major teaching affiliate of Mount Sinai School of Medicine. Many tables involved!

When I left Jersey City Medical Center all my chairs immediately disappeared.

“Don’t just get involved.  Fight for your seat at the table.  Better yet, fight for a seat at the head of the table.”  President Obama, 2012, Barnard College

Revised: December 24, 2018 000000

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