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The District needs a new public hospital

(Published June 30, 2003)

Despite rosy pronouncements from the Williams administration, the District's current system for providing health care to the city's thousands of working poor and indigent residents is not working well.

In fact, the system is so fraught with problems that it is now difficult for anyone - wealthy or poor - to get quick attention in a D.C. hospital's emergency room unless death is imminent.

And the private health care providers whose efforts were contracted to replace services previously offered by the city's only public hospital (which was shuttered in 2001 to usher in the new system) are not being paid in an adequate, timely manner. Providence Hospital in Northeast Washington, a private facility with a reputation as being the city's only hospital that turns away no one seeking care, is fast becoming the District's de facto public hospital - but without proper public funding to compensate for its services.

At the same time, Chief Financial Officer Natwar M. Gandhi recently estimated that the new indigent care system's funding is so out of control that it will cost taxpayers $44 million more in the current fiscal year than the original $71 million that was budgeted. And that $115 million for one year does not even include approximately $6 million annually still being paid by taxpayers to keep the dilapidated campus of former D.C. General Hospital operating for use by health care clinics. Nor does it include numerous other costs, including school nurses, previously borne by D.C. General's budget.

For perspective's sake, consider that the forever-meddling Congress was so incensed by taxpayer subsidies to the quasi-public Public Benefit Corp., which operated D.C. General and its clinics, that it capped them at $45 million a year. And building a brand new public hospital would cost taxpayers about $100 million, judging from the $96 million price tag of the new state-of-the-art George Washington University Hospital, which opened last August in Foggy Bottom with luxury suites.

Several members of the D.C. City Council, which unanimously opposed Mayor Anthony A. Williams and the now-dormant financial control board's roughshod imposition of privatized health care for the poor, recently complained that the current system requires taxpayers to write a "blank check" for its funding.

None of this should be a surprise to anyone. The current scenario was predicted loudly by opponents of the plan to close D.C. General and replace its services with a network of private health care providers. Those opponents included almost everyone except the mayor, then D.C. health director Ivan Walks and the control board. Most of the health care providers who are now scrambling to make the flawed system work as best it can also opposed the new system's implementation.

Two years after D.C. General Hospital's closure, the public still has never been given the full story to explain why the mayor and control board were so "hellbent," as Councilwoman Sandra Allen recently described their demeanor of the time, on handing a five-year, multimillion-dollar contract to Greater Southeast Community Hospital to manage the new health care "safety net" system. The D.C. Health Department, which has had well-documented problems administering its contracts over the years, recently took over management of the "safety net" when Greater Southeast filed for Chapter 11 bankruptcy protection.

So, taxpayers are almost back to square one: The D.C. government is once again financing and managing health care for the city's poor, but without owning the proper facilities (i.e., a fully-equipped hospital and associated neighborhood clinics) to maintain public control of the costs.

This situation must be remedied now. D.C. needs a new public hospital system. The costs of providing such a system are known. The city should use its new "A-" bond rating from Wall Street to get moving on plans to finance construction, either on the current D.C. General campus or at a site adjacent to the Minnesota Avenue or Deanwood Metro stations - the one section of D.C. that lacks a nearby hospital.

Copyright 2003, The Common Denominator