The Health Care Crisis
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health insurance to cover the procedure? What happens if a lack of medical insurance prevents you or your family from seeing a doctor, which could result in health problems that had not been identified but could have been treated before they became life threatening? These scenarios may seem far-fetched, but these types of situations happen to people who lack health coverage everyday. There is a true story about a patient who was insured and diagnosed with treatable cervical cancer. Unfortunately, she lost her job and with it her insurance. She was then unable to see her private doctor, and was turned away from other hospitals because ?cancer treatment is not considered an emergency in a patient who can?t pay? (?Help for D.C.?s Uninsured?). The woman later died at her home without ever being treated. This example raises the question, since when are people with less money less deserving of health care or appropriate treatment?It is hard to imagine life without health insurance. If you have any type of medical problem that requires attention, and you have appropriate health care insurance, you can be cared for in the finest of private hospitals. You can get great treatment and your ailments, depending on the severity, can be treated as soon as possible. Doctors, physicians and surgeons are willing to put out a big effort if they know that they are dealing with patients who are insured and have the money to go under extensive medical treatment. But imagine life without such luxuries. For example, what happens if a relative requires much needed surgery, but does not have
The District of Columbia fares terribly when it comes to health care. Avram Goldstein is a journalist from the Washington Post who has written numerous articles on the health care situation in D.C. Goldstein has worked for the Post for nine years but has been covering health care for numerous years as an investigative reporter and as an editor in many newspapers. As an expert on the issue of health care, he states in one of his articles, ?If you live in the District without health insurance or a regular doctor and you get sick, city officials and health administrations have an important message for you.
Good luck? (?For the Uninsured?). This quote makes the admission that there is indeed a crisis situation health care in the District, and there is not a quick solution. The main problem is that it is not rare for D.C. residents to lack health insurance. As of 1999, ?approximately 80,000 people in the city lack[ed] health insurance? (?Help for D.C.?s Uninsured). There are few hospitals that would offer to attend to the need of such helpless individuals. For 195 years, D.C. General Hospital provided care to the indigent, serving almost 200,000 patients a year. D.C. General was an exception, as it became a public hospital whose primary purpose was to treat and cure patients who could not afford medical care:
One Washington resident in six lacks health insurance, and more than 600 patients were transferred to D.C. General by other hospitals last year for lack of ability to pay. The hospital, like all hospitals, is being squeezed by tighter Medicare and Medicaid payments. Then there are urban poverty, homelessness, pregnancy among ill prepared teen-agers and rampant drug use. The city?s infant mortality, cancer, homicide and death rates are distressingly high (Cohn).
The effort to help those who suffer from lack of health care insurance is a noble one. Yet, D.C. General did not fare well financially. In an interview with Avram Goldstein, he reported that there were many aspects of D.C. General that posed problems to the community. One main problem he noted was that the hospital used up too much of the taxpayer?s money. Mayor Anthony Williams battled the D.C. council for years because he felt the public would best be served if D.C. General closed its doors. This kind of thinking seems rather illogical, because D.C. General was a public hospital that cared for those who lacked medical coverage. Public hospitals take in the people that private hospitals refuse to see. D.C. General did the District a great service, and it should have remained open in order to care for D.C.?s impoverished.
D.C. General, first called the Washington Infirmary, was built in 1806 and was the first public hospital of its kind. The building was renamed a couple of times, and it was finally given the name District of Columbia General Hospital in 1953 (DC General Hospital). The area is considered to be one of the most historical medical sites in Washington, D.C. Since its inception, D.C. General?s primary purpose was to serve the less fortunate ? those members of the District who could not afford medical services. There are certain advantages to a public hospital as well. Physicians and doctors will not mislead their patients because there is no financial incentive. Also, the patients will not be ?vulnerable to quality cheating [of equipment and treatment because the hospital is not] a profit-maximizing firm? (McArdle 51). This kind of practice was especially important in the District, because they have always ranked poorly in terms of health care compared to the rest of the nation. A report from 1979 reads:
By all commonly accepted indicators of the state of a people?s health, the District of Columbia is almost as health-poor in 1979 as it was a decade earlier. The city still has the highest urban infant mortality rate in the nation, almost twice as high as the national rate?The city has the highest cirrhosis of liver death rate in the nation. The city has the fourth highest tuberculosis rate in the nation?The city has one of the nation?s highest venereal disease rates (Colen).
These are the types of problems that D.C. General dealt with on a daily basis. They treated the indigent when it was too late for the indigent to be cured. It is therefore difficult to compare D.C. General to other types of hospitals, especially private ones, when many of their patients often came to them sick or dying. Many admired what D.C. General was trying to accomplish and the hospital gained many advocates over its 195 years of existence. If such a hospital had never been founded, the District?s health care services would have been in an even worse condition.
This thought raises the question, ?Shouldn?t every patient be able to receive a form of adequate care?? Jean Pratt, an author who studied the situation of health care for the mentally ill, wrote about the idea of ?constitutional right? to health care in her study. In her study, she included the fact that ?the concept of a patient?s constitutional right to treatment was first suggested?in 1960? (Pratt 29). Some people see withholding care from those who need it as being cruel and unusual punishment. In ?Article I, Section 8, Clause 1 [of the Constitution] Congress [is given the] power to ?lay and collect Taxes and provide for the general Welfare?. It is this clause that gives authority for most of the Federal support of medical research, health planning and regulation, and direct provision or financing of health care? (Fuenzalida-Puelma 506). Although there is not a direct statement in the Constitution about right to health care, many also consider that the right of health-care could fall under the rights to ?life, liberty, and the pursuit of happiness?. The framers of the Constitution could not account for the major scientific developments that would occur two centuries after the Constitution was signed. Federal government?s role in health care began as a limited one, but as the 1960s approached, Medicare and Medicaid were established. These programs? primary goal was ?to provide financing for care of the aged and the poor, respectively?[and] while Medicare is administered solely by the Federal Government, Medicaid is more typical of U.S. social programs? (Fuenzalida-Puelma 507). Both programs involve the Federal government to a certain degree, emphasizing the idea that all citizens are entitled to health care in one form or another.
Health care may be a necessity for the American public but unfortunately the medical field can be run like a business, especially because ?the medical industry has always been dominated by agents that earn profits? (McArdle 47). Just like any other business, social lines have also been drawn which means that some people will be favored and others will be denied. These lines, or divisions, are verified by the government, as proven through the numerous welfare programs that have been implemented over the past 40 years. Many physicians may want to steer clear of such programs because ?some specialties and services included [in a program like] Medicare today might not be included in a competitive environment because they would not be?attractive? (McArdle 170). Businessmen and sellers of goods run to the rich because the rich can afford the better, lavish treatment, and the poor cannot. This sense of favoritism reinforces the idea that there has never been a sense of social equality in our world.
Classes are ?derived from a society?s economic relations [?] Debate about class often revolves around three core issues: social opportunities, identities, and politics? (Lipset 303). It is obvious that the homeless and poorer residents of the District, and around the world, do not have the same advantages as the members of the upper class. Some people believe that these advantages and the idea of ?separation of classes? are fair. For example, ?[Herbert] Spencer and [Graham] Sumner [two Social Darwinists] argued that government programs to protect the poor?only worsened their lot by depriving them of energy and incentive to improve their economic condition? (Lipset 109). Charles Darwin spoke of ?survival of the fittest?, that only the strongest members of society will live and thrive in their environment, but does that really mean that poorer people should not be cared for (Lipset 108)? Most would agree that the poor people are certainly deserving of adequate care, which is why D.C. General provided such a great service.
It is true that D.C. General suffered financially. ?In fiscal [year] 1987, the hospital?s operating budget was $105.4 million. The District contributed $42.4 million [?] In fiscal [year] 1989, the District proposed to give $50.9 million toward a $111.8 million budget? (Cohn). Obviously, D.C. General?s budget continued to increase, and it was not making any profit. It is difficult for the hospital to be profitable, when profit isn?t its main concern. Mayor Anthony Williams believed that there was a less expensive way to give and extend medical care to the poor. Williams? considered the health care system in the District to be extremely below par, and D.C. General?s reputation did not meet Williams? standards. He made a proposal to ?severely downgrade the Hospital to a so-called ?community access model?, transferring the trauma center to Greater Southeast Community Hospital and privatizing the facility? (Schwartzman). According to Williams, ?those positive factors [of the hospital] were outweighed by persistent management failures and the hospital?s growing demands on the city budget? (Goldstein, ?D.C. General Sends Off Its Last Patient?). The plan did make sense in one respect because it is true that the health care market is constantly changing and there are certain problems with non-profit hospitals. They are a ?higher cost because of dissipated financial incentives to control cost? and they are less likely to have quality care because there is no competition (McArdle 53).
Avram Goldstein argues as well, that D.C. General was a ?horribly abused institution? (Goldstein, Interview). Residents from Maryland and Virginia were utilizing the hospital simply because it did not cost any money for this form of health care. He therefore feels that D.C. General was sucking up money that was coming out of the taxpayers? pockets by financing the healthcare of people who weren?t even residents of the district. The only reason that the hospital stayed around for as long as it did was because it was a ?union led battle; medical residents and employees fought the closing?. According to Goldstein, the problems with the hospital continued to evolve as time went on. The hospital was overstaffed, and the workers were not motivated. The equipment was out-of-date, so the medical treatment was well below par. Patients were not receiving any bills, and the record books were in complete disarray. A lot of money was going into terrible care. Goldstein views the D.C. Healthcare Alliance, a program that was meant to insure District residents without medical care, a much better option for the community. It is much cheaper, and there have not been any complaints since the program was put into effect. This is an interesting fact considering that the program has been put under a lot of scrutiny. Goldstein considers this scrutiny to be beneficial because improvements can easily be made. He believes that if this program is successful, the ?District could become a model for other large cities that can?t have regular doctors?.
Despite Goldstein?s support, Williams? proposal stirred up the D.C. community. Many of the residents in the District became advocates for the hospital and started to protest against the mayor?s proposal:
?I think it?s very easy for political leaders to fail to understand the relationship that a public hospital has with its community,? said Sara Rosenbaum, a George Washington University law and public health professor who has watched D.C. General and consulted with city leaders on its operations. ?It?s like a church ? it?s an edifice in the community, and its doors are open,? she said. ?The care inside may not be what it should be, but the psychological power of it is enormous? (Goldstein, ?D.C. General Sends Off Its Last Patient, A01).
A lot of members in the city?s community did not have faith in the mayor?s plan, and activists began to protest and propose ideas so that the hospital could stay open. The many ?critics of the mayor?s proposals point to D.C General?s critical role as the largest safety net provider for tens of thousands of residents without health insurance? (Schwartzman). According to David Schwartzman, the activists proposed numerous tax reforms; including making the wealthy pay an equitable amount of taxes to help the community with its finances. They proved to be well prepared, providing facts to support such proposals. The mayor not only faced opposition from the community, but from D.C. Council members. Kevin Chavous, a member of the D.C. Council who tried to run against Williams for the mayor position, stood in extreme opposition to the closing of D.C. General. The council voted against Williams? decision to close the hospital, a decision that Williams later had overturned by the D.C. financial control board. The battle that the D.C. Council had with Williams and the financial control board was ongoing, and members of the Council even considered suing them (Pierre). Despite the community?s vocal opposition to the closing of an extremely significant medical center, Williams had his way.
It is certainly difficult for politicians to relate to the poor and indigent. They cannot identify with the suffering that they go through, but they may offer compassion and sympathy. Yet this compassion and sympathy does not help the poor and indigent receive much-needed health care. It takes time for a person to become accustomed and comfortable with their hospital and as GW professor Sara Rosenbaum implies, people value their hospitals very highly. It is a place that symbolizes hope, understanding, and life. Although Mayor Anthony Williams believed that he was doing the right thing by closing down the hospital, he failed to realize D.C. General?s importance. It was not simply about giving health care to the less fortunate, but it was about 195 years of trusted, honest care.
The D.C. Health Care Alliance is in its initial stages, which may explain why the program has had some temporary problems. Yet, that does not excuse the fact that the program has not been utilized by many of the District?s uninsured. This program was implemented under the direction of Mayor Williams, and eligibility rules were set to prevent people from members of the community from ?abusing the system?. Unfortunately, many former patients of D.C. General do not even know about the program. Others may still be attached to D.C. General and may not want to go to another hospital, perhaps in fear that it will close on them too. Other former members of D.C. General might not meet the eligibility requirements and may be rejected for care. In a few of articles presented by the Washington Post, numbers were given for clinics and health centers that could attend to the need of former D.C. General patients (Goldstein, ?For The Uninsured?). It seems difficult to believe, though, that former D.C. General patients would be willing or able to access these clinics. Most of the D.C. residents who accessed D.C. General are well below the poverty line, and it would seem that many do not even know that the options of clinics or health care centers are open to them.
Considering that the D.C. Health Care Alliance is off to a slow start, it is important propose other ways to improve the state of health care among poorer residents in the District. While attempting to fight the closing of the hospital, the D.C. Council board provided different proposals in their wishes to keep the hospital open. One solution was to ?turn indigent health care over to private providers? (Pierre). Another possible answer would be to utilize D.C. General and make it a training hospital, so nurses and doctors would be more equipped and more skilled to provide better care.
It would seem that Williams? motives to closing the hospital were purely financial, in his hope to save his city money. As his critics noted, ?It is less expensive to provide preventive care to an insured person than to provide treatment to someone without insurance? (?Help for D.C.?s Uninsured?). It has become evident, after D.C. General closed its doors on June 25, 2001, that the closing happened because everything in the world today is about profit. There is now a business-oriented side to the medical profession. The power is no longer in the hands of the doctors or nurses, but instead the government and those who oversee the finances. This statement is proven true with the example of D.C. General and the fact that ?the D.C. financial control board has legal authority to impose a contract and close [a] hospital without approval? (Goldstein, ?Council Members?). Many articles covering the closing of D.C. General focus on the idea of competition in the marketplace, but since when have hospitals and medical care been about competition (Goldstein, ?D.C. General Sends Off Its Last Patient?)? When Stuart Seides, president of the Medical Society of D.C., learned that D.C. General was to be taken over by a medical company from Arizona he wondered if ?it [the Arizona Medical company] was interested in capturing dollars by somehow shortchanging the people they?re supposed to serve? (Fisher B01)?
If Williams was more worried about the welfare and medical care of the lower class, than concerned about finances he should have kept D.C. General open. His plan for the D.C. Healthcare Alliance, although not considered a failure, is not an amazing success. General Southeast Community Hospital?s trauma center did not open in time, and ?the number of people using the services of D.C. Healthcare Alliance is well below projections? (Goldstein, ?D.C. Health Program Defies Predictions?). Perhaps this is because the less affluent do not even know about the D.C. Healthcare Alliance ? a program that involves numerous hospitals in D.C. that have come together in an attempt to provide health care to the destitute ? exists. After relying on D.C. General for so many years of their lives, many people have yet to realize that there are new options open to them. Recent statistics have shown that ?thirty to 50 alliance enrollees a day are in hospitals, far fewer than D.C. General?s average?it turns out that thousands of them [former patients of D.C. General] weren?t eligible for that care [from the alliance]? (Goldstein, ?D.C. Health Program Defies Predictions?).
D.C. General was certainly a hospital with a great heart and a great mission. It took in patients no matter their race, gender, ethnicity, or social class. Their goal was to treat all different types of patients, not just patients who could afford expensive surgery. They did not put a price on health care, because the value of a person?s life is indeed priceless. Mayor Anthony Williams may have had great intentions in his hopes to cut back on the city?s finances, but finances and profit should not be the main concern when it comes to a hospital providing health care. In today?s society, it is hard to say that any type of ?business? should stay open because it has a good heart, but when you have a ?business? like D.C. General, closing it means breaking the hearts of all of the people who trusted and relied on it. Any business like that should always have its doors remain open.
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