MAYOR ANTHONY Williams is taking on one of the most difficult problems facing the District: a misshapen, politically entrenched health care system. This summer he will assemble hospital executives, patient care experts and public health professionals to seek consensus on squaring human needs with health care resources. Residents in every quadrant have a major stake in the outcome.
A number of D.C. hospitals face hard times. Patient loads have declined to the point where the city has more beds than patients; only half the licensed beds were used last year, according to Post staff writer Avram Goldstein. The District's trauma-care network, consisting of six separate hospital trauma centers, "is so extravagant," he reports, that "it has become the butt of jokes in medical circles."
And as D.C. hospitals compete for a shrinking pool of insured patients, Medicare and Medicaid are cutting hospital reimbursements, and health insurance plans are shifting more patients away from more expensive hospital care. Those are predicates for what the mayor says is a health care crisis.
Rationalizing health care delivery among competing hospital interests is made more difficult by institutions that resist the thought of losing patients, even in the name of better patient care. Sara Rosenbaum, a George Washington University public health professor, observes, for instance, that D.C. General -- unable to attract many insured patients -- relies on the uninsured as a means of ensuring receipt of public funds. Providing the uninsured now flocking to D.C. General's emergency rooms with insurance, notes Dr. Rosenbaum, would make those patients more attractive to other hospitals or primary care providers. But giving residents the freedom to choose their doctors rather than relying on the emergency room might leave D.C. General the loser. That fear helped doom the mayor's plan to cover 39,000 uninsured residents.
The status quo makes taxpayers and uninsured patients losers. That's why the mayor's initiative is important to the entire city.