As I write this column, Congress is still debating whether to approve the $700 billion Wall Street bailout, and the presidential election is a month away. Like everyone else, I’m uncertain about the future. Many of us are keeping a vice grip on our checkbooks until the credit markets loosen up again. No matter what happens, we’re going to be living and working on less in the year ahead. Business—like people—thrives on certainty. Stability allows us to budget and to make important decisions about when to expand, when to invest, when to get a loan and when to add or subtract employees.

Without such stability, there’s not much we can hold onto except our faith in our business’s mission and our political system—and however skeptical I may be about the current health of the financial  markets and my own little 401K, I do believe in both of those.

While the bailout may be the story of the year, health care remains an urgent topic. In this issue, we look at healthcare close to home. Our cover feature is about Gwen MacKenzie, the CEO of Sarasota Memorial Hospital, whose job is to make sure the hospital’s bills are paid while providing the best healthcare possible to residents. While it’s always been hard to budget for the hospital since, as MacKenzie points out, the costs are dictated by everyone else—private insurers, Medicare, Medicaid, charity care volume—it’s even harder now. David Verinder, the hospital’s chief financial officer, says predicting what’s going to happen to interest rates on the hospital’s debt or anticipating the volume of charity care cases in 2009 is impossible. Predicting next year’s property tax revenue—a large portion of the hospital’s operating budget--is also daunting. “We didn’t predict the rate of decline that we saw this year,” he says. (That decline cost the hospital $10 million.) And who knows what will happen with the hospital’s investment portfolio.

MacKenzie is known as a cost cutter, and she made some painful decisions this year when she laid off 31 employees and cut 100 vacant positions. She also went to every department in the hospital and required they follow the budget they were given. Her frugality is paying off—at least financially. The hospital is on sound financial footing and is receiving top marks from international credit rating agencies. And Sarasota Memorial continues to rank high in patient care in the geriatrics specialty and in nursing care.

In other stories, Kelly Kirschner reports on the health of the funeral home industry in “Alive & Well,” and Johannes Werner looks behind the state of Florida’s policy on ethanol in “Got Ethanol?” to see who’s really going to make money on this controversial biofuel.