Medicare turned 38 last week, and Senate Democrats handed out cupcakes to mark the occasion. But the Capitol Hill birthday party took a typically partisan turn when Senate Minority Leader Tom Daschle (D-S.D.) and some of his colleagues accused Republicans of conspiring to "eliminate Medicare as we know it."
Daschle, one of eight Democrats working on a House-Senate conference committee to negotiate a Medicare reform bill, says Medicare has been "a major success and we intend to do everything we can to keep it." That may not be so easy.
Republicans on the conference committee have held secret meetings without inviting the Democrats, Sen. John Rockefeller (D-W.Va.) says. "These are not good times for Medicare conferees," Rockefeller says, adding that Republicans have staged "photo-op meetings" but none that are bipartisan or productive.
Conferees are expected to produce a final bill sometime in September, but a host of controversial issues could imperil an agreement. A House provision known as "premium support," which would put Medicare in competition with private health plans starting in 2010, is a particularly tough hurdle. "It would be very difficult for us, even with our wildest imaginations, to find a way to support premium support," Daschle said at the birthday party.
So much for cupcakes, conference committees and birthday celebrations.
Erect an ER
Like society itself, hospital care is rife with disposable items: gloves, sutures, catheters, surgical tools-you name it. So why not a disposable hospital?
In fact, three Virginia companies have done just that, producing a prototype disposable facility outside Pittsburgh that would be used to isolate patients in the event of a terrorist attack, a natural disaster or the outbreak of a fast-spreading deadly disease. Once the crisis of the day has passed, the entire hospital can be disassembled.
The 6,000 square-foot, 150-bed structure, officially known as the Emergency Isolation and Treatment System (EITS), will be erected sometime this month as part of a federally funded initiative with the Allegheny County Bureau of Emergency Services. The Daedalus Project, Alexandria, Va., which originally intended the polymer composite panels that will be used in the hospital for low-cost housing projects in developing countries, has teamed with corporate partners AT&T Government Solutions, Vienna, Va.; and Radian, also of Alexandria. The trio is seeking a hospital supply company to join them.
Edward McCulloch, president of Daedalus, says the project is based on the simple premise that the response to "emergencies implies recovery, which entails costs." The price of a fully functional emergency isolation and treatment system is expected to be less than 5% of a modern hospital, he says. Excluding equipment and furnishings, the total tab for a 500-bed structure-or a much larger facility than the prototype outside Pittsburgh-is approximately $525,000, says Marilyn Wilson, Daedalus' director of marketing.
What's more, this new style of hospital can be deployed in only 72 hours-about the time it takes the typical state health department to turn down a certificate-of-need request.
The tribe has spoken
J. Philip Hinton isn't much of a gambler, but he hit the jackpot in a local Indian-run casino last month without so much as placing a bet or rolling the dice.
Beaming like a lottery winner, Hinton, CEO of Community Medical Centers in Fresno, Calif., cheerily announced last month that his cash-strapped, three-hospital system had received an unrestricted, $10 million gift from an Indian tribe that operates the nearby Table Mountain Casino. "It's absolutely amazing-absolutely amazing," Hinton says.
The gift, which will be paid over the next decade, was a way for the Mono-Chukchansi Indians to "give something back to the community," Hinton says. About 80 members of the tribe, once ranked among the poorest in the nation, operate the Table Mountain Rancheria, a reservation in the foothills about 20 miles northeast of downtown Fresno. The annual revenue of the casino, one of 45 Indian gaming sites in California, is estimated to exceed $100 million.
"For years and years, they were poor people who had to go to safety-net hospitals," Hinton says. "After opening the casino, they became quite wealthy. It didn't take many years for the tables to be completely reversed. Now, they want to help one of the safety nets that helped them."
Hinton says the money-including a $2.5 million check scheduled for delivery this month-will be used to support programs like Community's Level I trauma center, asthma care and a prescription drug program for the poor. The pledge comes at a particularly opportune time for Community, which, like most hospitals in California, is struggling to cope with state budget cuts and the huge costs associated with nurse staffing. Community's disproportionate-share payment, Hinton says, has been cut by $7 million in the last year.
The generous pledge is the biggest single gift ever for the hospital, easily eclipsing the previous record of $2 million from a local foundation, Hinton says. He also says hospital staffers believe their research indicates that it may be the largest gift ever by an any Indian tribe to a healthcare organization. "We couldn't find one any bigger," he says.