RFPs aren't plans, neither are piecemeal responses

Today's Post reports, in "DC moves to control failing hospital in SE‎," about the city government takeover of the United Medical Center, a hospital in Southeast DC formerly called Greater Southeast Hospital, because of financial distress.

This has been a pretty common occurrence over the past 10 years in many cities (e.g., Atlanta, Los Angeles, Nashville) and in Prince George's County, Maryland with regard to the county owned hospital there. Meanwhile, desires for hospital organizations to win new customers in the suburbs continue apace. In the DC region, Suburban Hospital and the Washington Adventist Hospital vie for the privilege of building a hospital in North Montgomery County, while the Fairfax-Prince William hospital market is controlled by INOVA, which works diligently to keep out competitors.

When the PG County issue was more significantly in the news, along with Howard University's bid to get the city to build it a new hospital in Greater Capitol Hill, I argued that problems with hospital care and financing in PG County were derived from the same circumstances faced by DC, and that a regional solution would likely be in order.

See:

- How to Solve the Hospital Crisis
- The focus on hospitals vs. issues of health
- Muddled thinking by Steven Pearlstein (Post business columnist)
- An opportunity for rethinking health and wellness care in the District of Columbia
- Health Planning vs. Hospital Planning redux
- Piling on the hospital issue

I still believe that a regional solution is in order. We don't have have a health care and wellness plan for the city or the region.

It's the same issue with "national health care" or "national health insurance" requirements and the national debate and opprobrium ("Obamacare") over creating a national health type program in the U.S.

Health insurance isn't the same thing as health and wellness care. The health insurance system was created during the Great Depression more as a tool to regularize income for hospitals than it was to create a system of care for people. That's why the health insurance system is structured in the way that it is, and it doesn't focus on helping people be healthy in the first place, so that they don't need medical care so much (obviously people get sick and need help but many diseases such as diabetes, heart disease, hypertension, etc., are in part driven by health behavior choices).

So many health problems are based ultimately on behavior (diet and other choices regarding such choices as drinking, smoking, and the care people take while driving and in other activities where accidents with catastrophic effect can and do happen), and only by addressing that can the health care "system" drive costs down.

I wrote about one way to do this in the city in "Disruptive innovation (once again) and "Bods/Cuerpos" but it turns out that Christopher Alexander expressed the same idea about 30 years ago in the book Pattern Language.

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WRT "RFPs" one of my lines is that "Requests for Proposals aren't plans."