god of development

[Dan Schmidt <schmidt6@Turbonet.com>]

I appreciate the postings of G. Brown and Bill London regarding the Alturas
Park. I would like to broaden this discussion to address the current
development discussions regarding the hospital consolidation. As responses
to Bill and Greg have mentioned, there are many sides to the
"goodness/badness" of development and tax support and the ethics of public
interest. I find these issues even more confusing in the area of
healthcare, where there is this sense of it being a public Right...almost
constitutional if Hillary had her way. It is not CLEARLY a right, although
most people agree it is a part of the common good, like clean water and a
measure of public safety.    
Still, many aspects of health care are clearly for profit. Tread carefully. 
	I have tried to talk with folks regarding this issue. It seems most are
too busy, or very opinionated one way or the other(i.e. too busy). An open
discussion of the ups or downs hasn't taken place in the public much(There
were a couple postings a few weeks ago...I could have jumped in then but
did not,i.e. too chicken)  Like Steve Cooke, I hope for a "community"
exchange, but have found editorialists instead fanning fires with not alot
of background to be offered. Of course, when the background is a 300 page
consultants study I can appreciate having something better to do. 
	Most doctors have an opinion about this, and I think lots of folks feel it
would be fine to let the medical folks steer this decision. Unfortunately,
I believe the public has an unhealthy trust of the medical professions
altruism. Doctors are businessmen/women too. So turning this issue over to
the groups who are the most likely to profit from the management of these
resources is OK if we accept the market economy nature of this business.
But then those folks should be at risk for this adventure too. This is what
the Specialists from Pullman are proposing with the OutPatient/Ambulatory
surgery center(ASC) they have on line for development in the corridor. But,
the public served by this ASC will most likely be the insured folks who
need minor surgery. This is a profitable venture. Capitalists will lend
money and business will be done. The trade off is that the hospitals who
currently make these profits and use them to offset their losses on
medicare patients will now have a lower, and probably negative, bottom
line. Bad? Surely painful.
	Does everyone know that 60% of hospital admissions(Medicare) are done at a
loss to the hospital? Most surgeries are also at a loss. Your insurance
premiums are going up to help pay for the balanced budget act savings on
Medicare. By separating the care, Medicare there, better paying insurance
here, this balancing act will dissappear to the public....for a while. But
it isn't going to go away. We just may not have to talk or think about it
right now. 
	 So, with shrinking Medicare reimbursement does consolidation of the two
hospitals answer this need for efficiency/productivity? This efficiency(if
there is one....and that is not altogether clear) will be at a cost. The
cost will be the change in the nature of care available to the citizens of
the Palouse. This, I believe is the God of Development that G. Brown was
referring to. It is not an evil god, or even malicious, but it is BIG. Is
big better? I'll bet the folks at the Vision2020 community discussion that
proposed the new business park didn't carry this thinking all the way
through. To the business owner, bigger profit is better. But then, that is
where the perspective is supposed to stop in a market economy. To the folks
of the Palouse, does a bigger Hospital sound better? A single hospital
serving most of Latah and Whitman Counties? 
	This is where I begin to feel like the martyr that G.Brown mentioned,
because I don't think the Business of Medicine needs to be bigger. I think
communities can be plenty healthy without lots of MRIs and Arthroscopic
surgeries.
	So, with my 250 word limit well past, I invite response. 
		Dan Schmidt  Moscow, Idaho