Old Tactics for a New Hospital
SUPPORTERS OF the proposed National Capital Medical Center (NCMC) are waging a vigorous public relations campaign. The center, a joint venture between the D.C. government and Howard University, would be a 250-bed hospital costing $412 million. Mass mailings, public rallies and organized lobbying by interest groups are some of the methods being used to influence the D.C. Council. These tactics are perfectly legitimate. But the case for the District to spend about $212 million building a state-of-the-art medical complex must be made not through politics but on the merits, based on health care needs, the immediate and long-term financial feasibility of the project, and the relationship of the proposed hospital to the District's health care delivery system.
The D.C. Council is ill-suited to conduct this type of objective, analytical review. That reality was on display this week during the Committee of the Whole hearing on using city funds from the tobacco settlement to finance the city's half of hospital construction costs. The rules governing legislative hearings severely limited members and witnesses from engaging in the kind of in-depth exchanges needed to evaluate the proposed hospital's impact on the city's medical needy and health care providers. The hearing demonstrated why submitting the proposal to the District's "certificate of need" process is so critical.
An independent review and analysis of the NCMC should examine assumptions that Howard and the city have made about costs, possible utilization, and the hospital's effect on the District's other health care providers and the health status of residents, particularly those with low incomes. It should also examine the proposed management and operational structure, balance sheet and financial viability, especially since neither Howard nor the city will be liable for the medical center after three years of operation. A certificate process would certainly fulfill that requirement.
Howard and D.C. officials are understandably concerned that the certificate process could delay the project by as much as five to six years. If so, that would be too long. The project should be reviewed on the merits, but within a reasonable period. City officials contend that the certification process of the U.S. Department of Housing and Urban Development, to which Howard would turn for mortgage insurance of its $200 million share, is a suitable alternative to the D.C. certificate process and that it has the added advantage of not causing delays. That alternative should be explored, provided the process is indeed rigorous and comprehensive.
The D.C. Council, however, is in no position to play the role of an independent, expert third-party reviewer of the NCMC. On an issue of this magnitude, with profound implications for health care delivery and city finances, politics must give way to sound policy.