THE D.C. Council is raising questions about $300 million included in Mayor Muriel E. Bowser’s proposed budget for construction of a hospital east of the Anacostia River. Questions about such a sizable capital cost need to be asked. But instead of wondering why the proposed hospital can’t be built sooner or asking whether it is big enough, council members would do well to address more fundamental issues. First and foremost: Is a costly new hospital at taxpayer expense the most effective way to address the health needs of underserved Southeast residents?
The District’s sad history in the hospital business suggests otherwise. So does the experience of places that have moved away from traditional inpatient facilities in favor of investments in outpatient clinics, free-standing emergency rooms, same-day surgery centers and other modes of health-care delivery.
“The days of the hospital as we know it may be numbered,” the Wall Street Journal recently reported in an examination of the national move away from sprawling institutions to smarter, more efficient systems. Yet the District, which already has an excess of hospital beds (in 2014 it had the nation’s highest rate of hospital beds per 1,000 people), has approached building a new hospital to replace the United Medical Center in Southeast as a given, not subject to debate.
The reason is politics. This is an election year, with Ms. Bowser (D) and a majority of the council up for reelection, and closing the only full-service hospital east of the river would be controversial, as then- Mayor Anthony A. Williams (D) knew when he shut D.C. General in 2001. He showed real political courage in making that necessary decision. Not only did D.C. General hemorrhage money, but also there were issues with quality of care that left many of the health needs of residents unaddressed. The city got sucked back into the public hospital business when then-Greater Southeast Community Hospital floundered and the city, with the best of intentions, rushed to the rescue. In hindsight, that was folly, and now $180 million later, the District is talking about laying out even more money to build a new hospital.
Administration officials said they are proceeding cautiously and point to consultant reports that call for a scaled-back facility, with 106 beds instead of the current 200-plus, that they contend would be economically viable. Finding the right partner, they concede, will be key, and, they say, there are credible providers that they won’t identify. They envision an opening in 2023, a date that Council member Vincent C. Gray (D-Ward 7), chair of the Health Committee, has slammed as not showing sufficient urgency.
The residents of Wards 7 and 8 need more and better health care, and yes, the city should play a role in solving the medical disparities faced by vulnerable populations. But building a hospital with no real consideration of alternatives is misguided. Think of what could be done with $300 million invested in preventive care, improved maternity and infant health programs, enhanced mental-health services, targeted acute care and other methods that have proved successful elsewhere. The political tunnel vision propelling the bid for a new hospital needs to end, and there should be thoughtful discussion of how best to serve health needs east of the river.