For poor who need healthcare, focus on people, not the place

[Guest guest]

For poor who need healthcare, focus on people, not the place

By Jackie Bueno Sousa

It's difficult to say exactly when we lost our way with regard to

Memorial Hospital, but I'm pegging it to 1945.

The City of Miami, which controlled the hospital at the time, was eager to be

rid of the cost of caring for indigent patients. At the same time, the

University of Miami was trying to start a medical school. So, in 1945, as part

of UM's effort, some community leaders suggested handing over the hospital to

the university.

It wasn't to be; the county refused to help pay for the care of poor patients if

the hospital were run by the school. And that's when it happened: Our focus

shifted away from ensuring health care for the indigent and toward ensuring a

facility where the indigent could receive care.

The distinction may seem trivial, but it has had a significant impact through

the decades, putting us on a course where decisions about providing health care

to our poor has become less about them and more about the multi-prong

institution that is .

Just consider the manner in which the county specified what's to be done with a

half-penny sales tax voters approved several years ago. Instead of stating that

the money would go toward indigent care, county rules specify that the money

must go to operate a " county public hospital. "

Now, our fixation with the place, rather than the people, is limiting solutions

for resolving 's current fiscal crisis. Those ideas include removing

from the county government's purview and converting it into an

independent, not-for-profit organization. Problem is that the $350 million in

yearly public funds can't go to a non-county hospital.

While we direct public health dollars to a facility, other communities have

wisely chosen to have the funds follow poor patients — no matter which hospital

they choose for their care.

It's easy to understand why we've become so focused on the place. It's a

physical cue that stirs some of our most vivid memories as a community and as

individuals. It is where we housed hurricane victims, where we fought influenza

and polio. It's also where many of us have gained and lost loved ones; my father

took his last breath there.

But that doesn't change the need for us to begin distinguishing between the

facility and the cause that created it. If we are to provide health care for our

neediest — which as a community we've repeatedly voted to do — then we need to

do so in the wisest and most efficient manner possible.

At the same time, if is to continue to exist, it must do so with a new

purpose.

You have to wonder what Gramling would say about the job we've done with

his vision.

A city judge, Gramling in 1908 helped create the Dade County Hospital

Association for the purpose of building a charity hospital. The idea held

promise: Physicians agreed to donate their services to help the indigent, while

the city promised to contribute as much as $9 a month to help cover the costs of

patients unable to pay.

Nonetheless, before long that first facility, a small, frame building called the

Friendly Hospital, was drowning in debt. In 1911, the association, unable to

meet more than $874 in operating costs, turned over the hospital to the City of

Miami.

The challenges had only just begun.

http://www.miamiherald.com/2011/06/21/2277750/for-poor-who-need-healthcare-focus\

..html