Sunday, July 10, 2016

Vibrant City; Charity Care

The Vibrant City
Friday evening, inbound on the Lincoln Tunnel is jammed with people headed to Midtown and the theater district. I’m starting to see this in DC, whose waterfront and restaurants are alive until 11pm on weekday nights.  The city is coming of age for what used to be a “quaint southern city”.
Enough old architecture remains bearing the marks of gentrification, bricks cleaned and painted jolly colors, new window frames, grout renewed. DC also embarked on a subway maintenance blitz; New York City has done this before, although alternate routings and express tracks have mitigates the effects on commuters. DC could certainly do better with alternate bus service, but this is where private industry is stepping in. Uber and Lyft, once demonized by establishment politicians, earned their right to exist as subway service is ending earlier on weekends. Bridj is operating red-and-white private buses that take those “in-the-know” to work- those with smartphone and credit card required. I have not seen “Google”-style buses yet, but I am not ruling out the possibility as the city proper becomes a hipper place than ever.

Charity Care: Alternative to Medicaid Expansion?
In the 1970’s, each state was required to establish central planning of healthcare, including “certificate of need”, removing the essential services of healthcare from the free market and traditional notions of supply-and-demand. It was argued that the process stifled innovation and competition, and the law was repealed in 1986, and over time, 14 states have abolished the system, and others have reduced the scope of central planning. New York was the first, in 1964, as Ronald Reagan and the American Medical Association railed against socialized medicine and Nixon’s individual mandate proposal. Next year is Virginia’s turn. A result of short legislative sessions, a bill passed by the legislature related to the issue was held over for next year. This was a result of strong bipartisan effort in suburban parts of the state. Balancing free-market ideals with the practical reality of health care access for rural residents. Imaging services like MRI and CAT will likely be the first to be liberated. This would be a boon for health care investors, and the Democratic governor, always looking to turn a buck, has shown support. It would also benefit the urban and suburban poor, who would be able to receive charity care on new healthcare investments, more than ever decentralized from large, regional hospitals. The cost of increased healthcare access would be assumed by private investors, rather than taxpayers under Medicaid. Two questions remain: How will this charity care be coordinated? How will rural access to healthcare be protected?

A New Subway in Manhattan
This year a new subway station opened up on the Hudson River in a newly vibrant west of midtown, formerly home to warehouses and meatpacking outfits. The station was built in the bedrock, and escalators connected from the street to the vaulted station a hundred feet below. One short flight of stairs connected the escalator mezzanine to the platform, a Spartan finish for a city that’s still kind of utilitarian. Soon, as in next year, a new line will serve Second Avenue on the notorious Upper East Side, and the Hudson River station is the builder’s model for sleekness in a subway system known for its grit.  Distinctly to the east of Lexington and Fifth Avenues, and retaining a village-like feel, I knew friends-of-friends who were able to afford apartments in the walk-ups that line the side-streets of Second Avenue. In a place where convenience comes with a price, I’d like to see if Second Avenue can keep its quaint, off-the-path charm.