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Narrative Matters

Politics And The Public Hospital In Our Capital

PREFACE: Public general hospitals like Bellevue (in New York City), Philadelphia General Hospital, and Boston City Hospital were once staples of urban America. Bellevue remains active today, but Philadelphia General closed more than twenty years ago, and Boston City has melded into the quasi-private Boston Medical Center. The expense, complexities, and "marketization" of health care have combined to cause cities to consider alternatives to the public management of large medical centers. Protracted debate over the closing of D.C. General Hospital in the nation’s capital is the latest high-profile battle over a public hospital. Paul Offner, a former health care finance commissioner, writes of his skepticism about the public hospital as the best buy for local taxpayers—a position that seems to have influenced subsequent events in Washington. As the CEO of Denver Health and a thirty-year veteran of public hospitals, Patricia Gabow writes from a very different vantage point. Civic will and clinical commitment, she argues, are the key ingredients to making a public hospital work. Where they exist together, public institutions can be powerhouses of service, education, and research.

I was sitting in my office in Washington, D.C., in August 1995 when out of nowhere came a call from Mayor Marion Barry asking if I’d be interested in running the District’s Medicaid program. I was no fan of Barry’s, holding him responsible for much of the city’s financial predicament, but the challenge was appealing. Out-of-control Medicaid spending had helped to drive the District of Columbia into bankruptcy. Furthermore, Washington had the highest infant mortality rate of any large American city, the third-highest AIDS rate, and the seventh-highest cancer rate. Having previously run Ohio’s Medicaid program, I had some experience . . . [Full Text of this Article]

Sacrificing A Dinosaur For A Good Cause

 

Resolution

 

Other Communities

 

A Brighter Picture

 

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