The seven candidates for D.C. mayor agree that health care issues -- particularly the soaring costs of treating the poor and uninsured -- will be a top priority of the next administration.
But in light of the District's mounting budget crisis, there are sharp differences over how to cope with indigent care, infant mortality, a record level of cancer deaths, AIDS, hospital layoffs and other symptoms of a public health crisis.
Proposals range from a landmark universal health care insurance bill co-sponsored by Democrat John Ray, an at-large D.C. Council member, to a suggestion from Statehood Party candidate Alvin Frost that the city find a better role model than Mayor Marion Barry, who was convicted this month on one count of cocaine possession.
"Rather than this image of being a 'night owl,' it might be good to see a mayor who goes to the gym twice a week, maybe plays basketball with the kids," Frost said.
Health care experts say the District needs a system that provides all its residents with a basic health care package. More important, they say, the city needs to convince its residents that they should care more about their health.
The D.C. Medical Society's political action committee has endorsed Ray, but the D.C. Hospital Association has declined to endorse a candidate, complaining that no one has shown leadership or seriously pushed an agenda for addressing health care concerns.
Ray's universal health coverage bill would phase in health insurance for about 114,000 uninsured residents, beginning at city hospitals that now provide an estimated $100 million a year in uncompensated care. The measure, Ray said, would "spread the costs to everybody," employers and employees as well as government and providers.
But lawyer Sharon Pratt Dixon, council Chairman David A. Clarke, Ward 4 council member Charlene Drew Jarvis and Del. Walter E. Fauntroy, while endorsing the universal coverage concept, balk at spending the tens of millions of dollars it is expected to cost.
Instead, these Democratic mayoral candidates said they would set up a funding pool or indigent care trust fund that would be financed by government, health care providers and employers -- particularly those that don't provide any health care insurance for their employees.
"The city is almost bankrupt," said Dixon, a former Potomac Electric Power Co. vice president. "Universal health coverage is only worth exploring at the point when we are financially healthy."
In the meantime, she said, insurance companies should help finance public clinics, and the D.C. government should help create a consortium of small businesses so they could better afford health insurance for their workers.
Former D.C. police chief Maurice T. Turner Jr., the Republican candidate, said he hasn't made up his mind about insurance proposals but thinks "it may be cheaper for the government to pay the insurance premiums for some of these people."
Turner, like the other candidates, would expand hours at the neighborhood health clinics. He would keep them open till 10 p.m.
Jarvis, who has targeted health care issues since her first race for mayor in 1982, said the city's high rates of infant mortality, cancer, tuberculosis, hypertension and other disorders exist largely because "there has been no real priority on community health care planning and prevention." As mayor, she said, her highest priority would be drug abuse treatment and prevention.
"Addiction is driving our entire budget, both in law enforcement costs and in fiscal and human costs of related problems," said Jarvis, who has been endorsed by the D.C. Nurses' Association and a group calling itself Physicians for Jarvis.
She would push for new approaches to drug treatment, including nutritional and amino acid replacement therapies, and she would extend mental health care support to addicts after their detoxification.
Fauntroy, who recently became a boarder baby foster parent, said the drug epidemic and infant mortality are major concerns. He would expand actions he took in Congress to fund prenatal care of drug-addicted parents and increase education in public schools for teenagers at risk.
"I think we've got to have Medicare coverage expanded to include working as well as the nonworking poor and for AIDS patient care," Fauntroy said.
All the candidates interviewed said they supported the council's recent emergency bill -- later vetoed by Barry -- to pay some of the insurance costs for AIDS health care workers at the Whitman-Walker clinic. Many cited a need for reform to limit malpractice liability. And all endorsed the creation of a Cabinet-level department of health.
"The advantage is that the public health budget would no longer be in a rob Peter to pay Paul situation, with monies for health care being used for other Department of Human Services activities," Clarke said.
Another area of agreement: Candidates would ask the federal court to take another look at a decree requiring the deinstitutionalization of mental patients at St. Elizabeths Hospital. They said authorities were too quick to release some of these patients before there were adequate living facilities and medical support in the community.
"About 25 to 30 percent of the homeless on the streets are suffering from mental illness and need to stay on their medication," said Ray. "I don't think sleeping outside in freezing weather . . . is what a human being ought to be doing."
Clarke said he would oppose any disposal of the hospital's west campus until the city makes greater strides in providing community facilities for former patients.