Sens. Robert Kerrey (D-Neb.) and John Danforth (R-Mo.) seem to have proved that governing indeed is sometimes just a game to the denizens of the Capitol.
Specifically, Messrs. Kerrey and Danforth-the chairman and vice chairman, respectively, of the Bipartisan Commission on Entitlement and Tax Reform-recently demonstrated for reporters a computer game that will help voters examine the effects that various program cuts, including Medicare and Medicaid, will have on reducingthe deficit.
The goal of the game, called Budget Shadows: Solving America's Entitlement Dilemma, is to score 100 points. A score of 100 means a player's choice of simulated cuts and tax increases will bring the Medicare and Social Security trust funds into balance and will not cause the deficit to rise as a percentage of gross domestic product by 2030. (Fiscal conservatives note: Balancing the budget yields a score of 115.)
In the demonstration, Mr. Kerrey asked a staff member to play the role of a moderate Republican who wants no new taxes or cuts in Social Security and thinks the so-called "mainstream coalition" that tried to develop an 11th-hour centrist healthcare reform bill was too liberal.
The staff member chose to raise the Social Security retirement age to 70 (five points), tax employer-provided healthcare benefits (nine points), and eliminate the federal tax deduction for state and local taxes (seven points).
Messrs. Kerrey and Danforth said they hope the game will be a way for Americans to understand the tradeoffs necessary to bring federal spending under control. Oh, and Mr. Kerrey boasted that he scored 100 several ways. He's just not telling us how.
Moving on.Tennessee Finance Commissioner David Manning, the chief architect of TennCare, the state's innovative managed-care plan that replaced Medicaid last Jan. 1, announced he's accepted a post as vice president at Columbia/HCA Healthcare Corp.
In his new post, Mr. Manning, 44, said he'll explore similar programs with other states. He'll certainly have the chance: Columbia/HCA operates some 200 hospitals. If its merger with Healthtrust goes through, the healthcare giant will operate 311 hospitals in 31 states.
"It's going to take market-based programs to control health costs. Columbia/HCA has an understanding of healthcare and where it's going, and I look forward to working with them," Mr. Manning said.
Outgoing Gov. Ned McWherter said Mr. Manning is "very accomplished, dedicated, a workaholic. You find people who want to implement results, but you rarely find people who can follow through and get results. TennCare's working."
New Natividad.A county hospital on the brink of closure seven years ago is being revived as one of the first hospitals in California with an emphasis on family medicine and increased outpatient services.
Natividad Medical Center in Salinas, the only academic medical center on the central coast, recently broke ground for a new $82.4 million facility. Completion of the facility is slated for 1997, but parts of the new structure will be occupied in 1996, a spokeswoman said.
The "New Natividad" acute-care facility will reduce bed capacity from 211 to 159 beds. It will be financed by county-backed long-term bonds to be repaid from hospital revenues. The county will lease a new medical office building to physicians and other medical providers, using the rental income to pay for construction.
Natividad credits its successful turnaround to its new chief executive officer, Howard Classen; its seven-member board of trustees; and the Natividad Medical Foundation, a fund-raising arm, the spokeswoman said.
Affiliated with the University of California at San Francisco School of Medicine since 1975, Natividad offers a three-year family practice residency.
Tongue-twister.Failed efforts by Congress to pass national healthcare reform will bring a new financial equation for academic medical centers, predicted Robert Waller, M.D., president and chief executive officer for the Mayo Foundation of Rochester, Minn.
Dr. Waller was recently the featured speaker for the Fourth Annual David L. Everhart Lecture at Northwestern Memorial Hospital in Chicago. The foundation's Mayo Clinic has been successful in establishing ventures "beyond the patient and into the communities."
Mayo boasts involvement in "35 managed-care networks" in several states outside of Minnesota as a way of expanding its patient base. The moves have helped Mayo change the way it does business.
"We would add up our cost and then set a price, but in the future there will be a price out there and we'll have to adjust our cost to that price," Dr. Waller said. "We'll go from cost-based pricing to price-based costing."
Class project.Children's Medical Center in Dallas got a little help recently from some young minds on its $50 million expansion project.
The 214-bed hospital and HKS Architects sponsored a research and design project for students working under the direction of George J. Mann, a professor at Texas A&M University, College Station. It's unusual for architecture firms and hospitals to turn to students for such help, but it's becoming more common for Mr. Mann and his students. About a year ago, A&M students worked with Children's Memorial Medical Center in Chicago on a design project (Dec. 20/27, 1993, p. 72).
For the Dallas job, 17 A&M students were given certain parameters. It would have to be a 170,000-square-foot addition with physicians' offices and eight more operating rooms.
The student designs flowed from a mix of skills, imagination and knowledge about the hospital and its mission to children. Some students used bright colors;one had a large balcony on the side of the building.
"There's probably two or three nuggets in every design that we'd like to pull from," said Marc Leediker, vice president of facilities development for the hospital.
The computer-generated design (right) is by students Brad Archer and Eric Herron.