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Health care requires a real plan
(Published December 16, 2002)


A funny thing happened to me about two weeks ago during a dinner gathering at which I was to speak briefly about health care issues in the District of Columbia. As the director of Health Care Now, an advocacy organization for health care consumers, I am often more than eager to speak of the need for consumer input in setting long-term health care policy in the city. In so doing, I am also aware of the need to maintain Health Care Now’s stature as an organization seeking multi-ethnic/racial participation in health policy decisions that cross class and geographical lines.

Among the guests were local activists who have participated with admirable energy and persistence in the movement to "save" D.C. General Hospital. Taking full advantage of the occasion, these guests decided to challenge me with a litmus test. They insisted that I state "for the record" that I support "without qualification" a public hospital for the District of Columbia. I readily complied – for the record.

The litmus test activists were also concerned that I and by extension, Health Care Now, had become agents of division and confusion in the movement to "save/re-open/rebuild D.C. Gen-eral." In order to address this latter concern, a more thoughtful discussion might be helpful.

Health Care Now was accorded the almost unprecedented status as a third-party intervener in the bankruptcy proceedings for Greater Southeast Community Hospital in 1998. That status permitted Health Care Now to represent the interests of the community and health care consumers and to give Greater Southeast time to devise a solution to its financial woes that would satisfy the court and maintain the hospital as Ward 8’s largest private employer and a provider of vital health care services. We will revisit this issue in the current crisis.

About a year later, following its Greater Southeast success, Health Care Now became a leader of the campaign to preserve in-patient services at D.C. General. The hospital reconfiguration and privatization of its services was the last major policy directive to the city issued by the Financial Responsibility and Management Assistance Authori-ty (control board), a creation of Congress whose purpose was to escort the District to financial solvency and "fiscal responsibility." Demonstrations, public forums and legal action marked Health Care Now’s activities to protect D.C. General and health care consumers in concert with a coalition of community groups, organized labor and activists for social justice.

In addition to its efforts on behalf of Greater Southeast and D.C. General, Health Care Now’s staff, board and members have sought to broaden the public discourse regarding the role of a hospital facility in a comprehensive public health care services system.

A public hospital is a facility offering many health care services through its diagnostic, treatment and clinical programs. Yet, the existence of a public hospital does not in itself assure the operation of a community health-oriented preventive care program.

D.C. General was a public hospital for almost half of its 195 year life, yet the District of Columbia has no comprehensive preventive care program. Health Care Now insists that a public hospital in the District be a key component of a preventive care system that targets the District’s multiple negative health status indicators.

D.C. General is a little over a quarter of a mile from the communities at River Terrace, Kingman Park, Langston Gar-dens, Parkside, Mayfair and other neighborhoods situated within a mile radius of the Potomac Electric Power Co. (PEPCO) power plant on Benning Road and the Anacostia River.

For three decades, these neighborhoods have formed the metropolitan region’s epicenter of illnesses and death due to cancer and environmental pollutants. Disproportionately high rates of juvenile and adult asthma and bronchitis have also been recorded in these areas.

Yet, for three decades, no one from D.C. General or the city’s Department of Health have visited to inquire or research the causes of the disturbing health outcomes and statistics these neighborhoods have generated. During this same period, residents have demanded the closure of the power plant, a cleanup of the river and repair of the obsolete sewage disposal sites that pump raw sewage into the Anacostia after just a mild rain.

Health Care Now has been designated a stakeholder for health action responses at River Terrace by the federal Centers for Disease Control (CDC). We have posed to the health department and D.C. City Council a set of demands developed in meetings with community residents.

We don’t ascribe sole responsibility to D.C. General for ignoring localized epidemics at River Terrace or elsewhere in the city. We do recognize, however, that without a comprehensive system of health care services – including geo-mapping and syndrome recognition, in which the hospital is assigned a key role – its status as a public hospital is of little importance to a child having difficulty breathing.

While Health Care Now supports a public hospital in the District, we cannot confuse having a public hospital with a solution to the city’s abominable health status, which more closely resembles Kenya and Bolivia rather than Canada or Japan.

Public ownership and operation of a hospital help to control costs by omitting the need to distribute profits to shareholders and should provide locally responsive management and accountability to voters.

Public ownership and operation by no means assure that the hospital is a component of a comprehensive, long-term vision of public well-being.

The mantra, "I support a public hospital in D.C." is neither a plan nor a vision. Health Care Now challenges all D.C. residents to insist that D.C. policymakers consult with health care consumers – particularly in the new Greater Southeast bankruptcy crisis.

Health policy issues – including an uncompensated care load formula for all city hospitals, broader insurance coverage, expansion of primary care programs, stable health care financing and a revised mission for the Department of Health – require well-developed plans, featuring consumer input from the beginning.

In addition, Health Care Now insists that we set achievable goals for the reduction of the morbidity of the District’s 10 top killers, which include diabetes, cancer, cardiovascular disease and HIV/AIDS. With such planning, distinct roles must be clarified for the city’s private and public health care facilities.

Copyright 2002, The Common Denominator