WHEN IT comes to providing health care for the poor and uninsured in Washington, everyone -- the local government, employers, developers, professionals, residents, hospitals and other health care providers -- should share the costs. That's the message in the D.C. Council's latest legislative attempt to provide better health coverage for Washingtonians. It must be stressed that the bill is at the public comment stage, but it attempts to address issues that deserve attention now.
Many D.C. residents suffer from diseases and illnesses that are preventable or treatable, but slightly more than one-fifth of the city's residents lack health insurance. That population has placed a heavy burden on the city's public health system and on private hospitals that are providing substantial amounts of free care. A related problem is the D.C. government's own worsening fiscal health. Council members John Wilson and John Ray are now floating a trial balloon -- parts of which will face vigorous opposition -- to gauge interest in sharing the burden.
The bill includes various ideas such as mandating employee health insurance, requiring health care clinics for children in the city's schools and an annual D.C. government subsidy to one trauma center in the city.
The bill would establish a trust fund and raise money through, among other things, surcharges on all occupations and professions licensed in the District, on all lawyers licensed to practice in D.C. and on insurance companies and health maintenance organizations. There would be an individual tax return check-off, and a two-cents per square foot charge on developers on projects involving at least 50,000 square feet of space. Certain funds recovered by the D.C. government on bad checks would also be used.
A full-scale solution really isn't possible on the local level, and the District government can only be expected to solve its share of a problem that is truly national in scope. Thus, it is more likely that the city will be forced to take on the issue in smaller chunks and set its sights a little lower. Many of the revenue generating ideas here will not be warmly received. The hospital landscape too may face changes. Hospital occupancy rates here average about 75 percent, which suggests that there is excess capacity.
Where should public health stand on the city's list of spending priorities, and which other parts of the D.C. government and its programs should be cut or curtailed to more adequately address such needs? For its part, the D.C. Council is right in struggling with possible solutions, but that path must invariably lead to even more difficult choices.