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Councilmember Phil Mendelson
Statement on DC General Hospital
March 6, 2001




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Phil Mendelson
Office: (202) 724-8064
Fax: (202) 724-8099

MARCH 6, 2001

I continue to want to be convinced that the proposal to dismantle the Public Benefits Corporation and contract out its benefits is best for our government. I agree with Mayor Williams' goal to enhance and expand primary care for our citizens. I agree with Mayor Williams -- and my Council colleagues -that the current public health system is not working and must change. I also agree with Mayor Williams that there should be -- should be -- universal health care for all District residents.

But I do not agree that the proposed plan will work satisfactorily. And if we shutter the hospital, I don't see how we can turn back.

I am struck by the fact that when we held a public hearing on this proposal last September, we were told that this plan was a model used no where else in the country. We were also told that, yes, response times for emergency and trauma care would increase by minutes -- by a significant amount when our emergency response times are already well above the national norms.
I am struck by the fact that when we held a public briefing 10 days ago we still did not have a clear plan of what is being proposed. Will there be level 1 trauma services at the D.C. General hospital site? Does the contract include continuation of services with the D.C. Jail and Correctional Treatment Facility? How can we be sure that the contractor will find inpatient hospitalization services at existing hospitals? --Especially given the history of uncompensated care at area hospitals and those hospitals' lukewarm reaction to this proposal. What are the performance measures for this contract? What happens if the contractor fails to comply with the requirements of the contract? And what happens in the outyears if we are unable to contain costs as this plan moves toward universal health insurance?

Ten days ago I asked for two documents: a simple synopsis of the proposal, and a side-by-side comparison of costs between the two bids and the current PBC. I have received neither. I cannot say the proposed contract is best when I don't know its terms and cannot compare its cost.

I did receive, however, a one-page chart comparing the current emergency-based system with the proposed, so-called "prevention-based healthcare system." The universal health insurance goal became clear to me from this chart: "all customers of the new system will become members of the DC-Washington Alliance," providing "HMO-type coverage for all uninsured residents." These are, perhaps, 40-60,000 people for whom we will not be reimbursed. Add to this the RFP provision to cover people with incomes up to 400% of poverty and who have chronic diseases such as diabetes and hypertension, and I ask: how do we control the costs for this? I cannot support the proposed contract when I don't understand how it is fiscally sound over the long run.

I do understand, though, that this proposal is not about saving money. We have been spending about $85 million per year for D.C. General. The bid for the proposed contract is about $83 million. This comparison is incomplete however, as the bid left out a number of services such as to the Department of Corrections, there are other government costs such as for a larger emergency ambulance fleet, and no capital costs are included for either alternative.

There is one last point. Supporters of the proposal to shutter the hospital and contract out are few. Significantly, the Medical Society is opposed and the Hospital Association is officially neutral. Medical experts are not telling me to support the proposal. Meanwhile, there is strong community opposition in many quarters. We are elected to balance good government with peoples' wishes. Here, the so-called good government option is not compelling, while the peoples' opposition is deep.

Where does this leave me? Financially, the contract proposal does not offer major savings. Fiscally, the proposal offers significant long term risks to our financial plan. Medically, the proposal increases emergency response times and relocates a much used level I trauma facility from a relatively centralized location to the southern edge of the city. Conceptually, we are still missing critical details. And in terms of the public will, the proposal is unpopular.

For these reasons at this time I cannot support the proposal to close our public hospital and establish an alternative publicly-financed health care delivery system.

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