Universal coverage may have been shot down at the federal level, and a single-payer ballot proposition in California was defeated, but in ever-progressive San Francisco, healthcare insurance for all still is possible.
Mayor Willie Brown has convened a task force of city officials and business leaders to examine the feasibility of forming a public-private partnership that would provide coverage to the city's uninsured. The group is expected to announce its findings in early 1997.
Sandra Hernandez, M.D., director of the San Francisco Health Department, has stated that the city must find an alternative to its current situation. The department spends some 20% of its $760 million budget to treat the 116,000 city residents who don't have health coverage. The federal welfare reform law is expected to add another 26,000 to the department's rolls at an annual cost of $93 million.
Among the initial, rudimentary proposals: a universal pool where all payers, including HMOs, Medicare and Medi-Cal (the state's Medicaid program), would make a contribution to pay for the coverage. Small businesses, which employ most of the city's uninsured, also would be given some unspecified incentives to provide healthcare coverage on their own.
Holy profit.New York's top Roman Catholic leader says there's no truth to a rumor that he disapproves of a contract between Saint Vincents Hospital and Medical Center in New York and Salick Health Care, a publicly traded, for-profit cancer-care company based in Los Angeles.
Cardinal John O'Connor set the record straight at Saint Vincents' Sept. 26 awards gala.
Under a contract announced in April, Salick will operate a 24-hour cancer diagnosis and treatment center under Saint Vincents' operating certificate, staffed by members of the hospital's medical staff. O'Connor said he supports the agreement because the hospital's chief executive officer, board and sponsoring congregation-the Sisters of Charity of St. Vincent de Paul of New York-support it.
The cancer-care project is, in some measure, a response to "the Kevorkians" of the world and the 2nd U.S. Circuit Court of Appeals, which has ruled in favor of "legitimizing" physician-assisted suicide, O'Connor said. The "answer," he said, is "pain alleviation," and that is what he believes the Salick agreement will provide.
Curley's friends.Cardinal O'Connor is a defector from the Catholic Health Association's hard-line stance against for-profits. In an unrelated development (we think) across town, CHA President and Chief Executive Officer John Curley Jr. sought out a new ally in his campaign to keep healthcare delivery not-for-profit.
He appeared in a New York hotel with officials of the American Association of Homes and Services for the Aging to highlight common concerns about the invasion of the investor-owned sector. At a press briefing, Curley said the goals of providing quality care shouldn't be subordinated to the profit motive.
"We must make sure that relationships with caregivers, in a long-term-care setting, a hospital or a doctor's office, are not undermined by financial incentives or self-interest," Curley said. "Yes, indeed, mission matters, and health and human services must be unselfish in meeting the needs of people and communities that are entrusted to our care," he added.
Curley described a 1994 report in Gerontologist magazine that revealed not-for-profit nursing homes have better quality, higher staffing and better patient outcomes.
When decisions are made on care, providers that don't exist to produce a profit for investors, have roots in the community, keep their legal obligation to provide community benefits and "take their mission to serve seriously" are preferable, Curley said.
Beltway bull session.Even by Washington standards, Veterans Affairs Secretary Jesse Brown is known as a master of mixing official and political duties-even at the risk of angering Republican lawmakers.
Rep. David Weldon (R-Fla.) took Brown to task for appearing last week on behalf of his Democratic challenger, John Byron, a little more than a month after spurning an offer to appear with Weldon in a "nonpartisan" town hall meeting to discuss a new outpatient clinic in Brevard County, Fla.
In a stinging exchange of letters last month, Weldon accused Brown of "shamelessly politicizing the VA" because he traveled on behalf of 13 Democratic members of Congress, but no Republicans.
Brown responded that the Republican-led Congress, Weldon included, voted to cut his travel budget 75% and "shackle me to my office in Washington."
Dueling PPACs.When you dip your spoon in alphabet soup enough times, the same letters are bound to come up. At least, that must be the explanation behind the name of the National Committee for Quality Assurance's new advisory group.
The Washington-based NCQA chose the name "Practicing Physicians Advisory Council," or PPAC, for the name of its new 19-member group that will allow physicians to have more say in the activities of the NCQA, which monitors the quality of care delivered by HMOs.
But lo and behold, there's another PPAC. The Practicing Physicians Advisory Council is the name given a 15-member panel established by Congress that advises HCFA on Medicare and Medicaid regulations affecting physician services.
"I'm surprised we wouldn't have known that," NCQA spokesman Barry Scholl said of the identical names.