The Health-Care Conundrum

The City Paper/YPP Project

by Doron Taussig

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Published: Feb 7, 2007

This is the first installment of a collaboration between City Paper and the local political blog Young Philly Politics. Over the past two years, YPP has become a place where politicians, activists and other present and future leaders go to discuss issues. In the run-up to the May 15 mayoral primary, we asked YPPers to brainstorm solutions to some of the city's problems, which we'll publish here in consolidated column form. This week's topic is health care, and your introduction is by Brady Russell, an organizer with the Philadelphia Unemployment Project (PUP).

There are eight public health centers in the city, committed to providing quality care to any and all Philadelphians. My organization has been around long enough to remember why that is: Back in 1977, when it closed Philadelphia General Hospital, the city committed to provide low-cost and free primary and pharmaceutical care to Philadelphia's poor and uninsured.

Much has changed in 30 years, and the commitment the city made then is not enough today. Many employers, faced with rising health-care costs, are cutting or eliminating employee coverage. As a result, fewer and fewer Philadelphians have access to quality and affordable health care; 80 percent of the uninsured are employed. Waiting time for an appointment at a health center can run up to six months.

About two weeks ago, Gov. Rendell announced a plan to "Cover All Pennsylvanians," and a new Democratic Congress may bring some relief. But it's going to be at least a year before either can deliver anything concrete. That's a long time to wait for those who need cancer screenings, blood-pressure medication and insulin today.

Philadelphia already has considerable health resources at its disposal: Three major medical schools, a vast array of private health centers and major players in the pharmaceutical and insurance industries are located here. And we have an economic incentive to improve health care: If our city wants to compete for jobs and new residents, anything it can do to lower health-care costs will give it a competitive edge.

What we need are leaders who can think creatively about this serious problem. So, what can candidates for mayor and City Council do to lower insurance costs, increase access to health care and decrease the risks that create a need for care?

The initial response to Russell's question was not to discuss what candidates could do about health care, but whether they should try. "The difference between legislation at the state and federal level [versus] the municipal level is, it is relatively easy for business to up and relocate in a city five miles away where it is cheaper to run a business," wrote "raideradam." Before long, though, participants moved on to kicking around proposals. Some of these called on Philly to step up and spend more money on health care, while others looked for creative ways to leverage the city's position and coordinate services. But, they were united in the conviction that there must be something a smart local government can do about health care.

Here are some key ideas:

Create a citywide health insurance pool. This proposal is a centerpiece of mayoral candidate U.S. Rep. Chaka Fattah's plan. It was explained on YPP by City Council at-large candidate (and regular YPP contributor) Marc Stier. "The secret to lowering health insurance costs is to create a large block of people to be insured and then using that block to negotiate for lower-priced insurance," Stier wrote. Such a pool would begin with government workers, and then other institutions — such as universities and businesses — would be invited to join.

Expand and publicize health-center services. Russell has noted on YPP that the PUP is campaigning for full-service evening and weekend hours at the public-health centers to meet the needs of working people, as well as for additional staff. Daniel Urevick-Ackelsberg, a founder of YPP and son of council candidate Irv Ackelsberg, added that many Philadelphians don't even know what the city health centers do, and that the city should put some effort into outreach.

Have the mayor negotiate a truce in the "technological arms race" between hospitals. Kati Sipp, who works on health-care policy for the Service Employees International Union (SEIU), was speaking only for herself in pointing out that when one hospital in town gets a new gadget, all the other hospitals need one to stay competitive. "What if the next mayor made all the hospital executives in town sit down with him and declare detente in this arms race?" she asked. "What if, instead of racing to acquire the latest imaging technology, our major hospitals agreed to share it, and to invest the extra resources in jointly opening a free clinic?"

Give local communities a say in hospital transactions. Sipp also observed that Graduate Hospital is being sold to the University of Pennsylvania, which will transform it from an acute-care hospital to a rehab hospital. "Does Philadelphia need one more rehab hospital?" she asked. "Or one less acute-care hospital?" Other states give residents a say in this sort of thing, and Gov. Rendell's plan takes steps in that direction. "The next mayor could work with Gov. Rendell to establish regional oversight of this kind of health-care expansion or conversion, which would allow activists and academics to raise concerns about hospital closings. ... Access to health care isn't just about health insurance — it's also making sure that there are providers in your community."

Increase investment in lead-poisoning prevention and expand services to pregnant and parenting youth. Alisa Simon of Philadelphia Citizens for Children and Youth noted, "In 2005, 7,600 children across the commonwealth were poisoned by lead — over 3,400 of them in Philadelphia," and that "70 percent of pregnant and parenting youth drop out and need additional supports to finish their education."

Attract medical research and link it with health care. Medical research requires test subjects. Stier suggested luring researchers by providing seed funding, and asking them to run their projects out of the city health centers, where they would provide free examinations and follow-up care to participants.

Require hospitals to do more in exchange for their tax breaks. Jennifer Jordan, also of SEIU but not speaking for the union, observed that most of the city's hospitals are nonprofits, and exempt from many taxes. In return, they're expected to "serve a charitable mission by providing 'community health benefits,'" but considering what they save, she believes, they could be doing more. In 1994, then-Mayor Rendell persuaded local hospitals to pay the city 40 percent of what their real estate taxes would be (less than other Pennsylvania municipalities). Jordan wondered if the next mayor might revisit this agreement, to see if the contributions could be increased.

Improve the EMS system. As City Paper has reported [Cover, "Emergency Breakdown," Mike Newall, May 12, 2005], Philly has an insufficient number of available ambulances and EMTs. "We need to get serious," said "redfox1," "about making sure that people aren't ending up dead or disabled because of slow or inadequate response to health emergencies."

(doron@citypaper.net)

To join next week's discussion about whether the ward system works, visit youngphillypolitics.com.

 

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