Buh-bye, Med Mart. Look Nashville, you have two convention centers!

Last February, readers, I told you that the Medical Mart, which Mayor Karl Dean promoted as a vital, job-creating replacement for the Nashville Convention Center and virtual compliment for the new Music City Center, was dead according to Cleveland news sources.

And, just like that, eight months later, Mayor Karl Dean is confirming that the Medical Mart deal is dead, with breathtaking lack of query now from Nashville's media, which breathlessly, seemingly unanimously, promoted Hizzoner's plan for a Medical Mart when its staging meant leveraging approval for the new Music City Center.

As bleated by WPLN and no doubt sponsored by the Mayor's Office:

Nashville Mayor Karl Dean sounds like he’s all but given up on the so-called med mart ....

Dean says the Renaissance Hotel, which is attached to the city-owned convention center, is interested in taking over some of the space. Dean says it’s a desirable piece of property that he’s not worried about sitting vacant long.

Not quite the optimistic narrative spouted out of the Mayor's Office and the media when the Music City Center was pitched to us. Now Nashville is simply "moving away" from the Medical Mart (even though 8 months ago we were limping toward it) according to the article by Blake Farmer, as if Karl Dean had never made certain promises under the pretense of building Music City Center. Would Music City Center have received quite as much promotional spin if Dean announced that his vision included the Renaissance Hotel shacking up in part of the old convention center? Doubtful.


Supplement: Jamie Hollin sees IQT lurking in the loss of Medical Mart. Given the Mayor's checkered past with IQT, Holins insights might not be far off.

Nashville about to be a city of two convention centers? Medical Mart rumored headed to Ohio

A Cleveland reporter notes that since his town threw its hat in the ring to be the home of the country's "first permanent medical showroom complex", it has had two worthy competitors in Nashville and New York City, neither whom look worthy any longer:

Now, almost four years later, it looks like the last of our competition could be circling the drain.

According to sources on the ground, med mart boosters down south are whispering that the Nashville project, already pushed back once over funding delays, is about to limp off to boondoggle heaven ....

The Nashville rumors are news to Jeffrey Appelbaum, an attorney hired by Cuyahoga County to oversee the project here.

“It goes to show you the value of the signed leases,” he says of Nashville. “We were constantly beat-up here because they were supposedly farther ahead because they had signed leases. Obviously, the signed lease is pretty meaningless without the go-ahead on the overall project.”

If Nashville has pulled up lame, that city’s tenants could become fair game for Cleveland, which thus far has taken a decidedly modest approach to lining up actual paying tenants for the $465 million play house you’re paying for. Technically, they haven’t mentioned any.

“I don’t know that anyone ever felt constrained from looking at some of the [Nashville] tenants anyway,” adds Appelbaum. He has no idea whether Cleveland’s developer, MMPI, has been in contact with the six companies locked into Nashville contracts....

In the process of selling Music City Center construction to a skeptical city, Mayor Karl Dean at times tied it to the Medical Mart as if the two were integral and coordinated rather than distinct and requiring separate work. The Med Mart was also sold as a major Downtown job engine and an effective repurposing of the Nashville Convention Center. But if Cleveland got it without putting a lot of the leasing work that Nashville did, does it indicate that our focus was off? Did we fail to get our budget together on a project that probably would have more immediate impact on local communities than the Music City Center will? Did MCC sap attention and resources from the Med Mart bid?

HT: Brandon Valentine

Developments at Meharry

According to Historic Nashville, Inc. things are looking up for Meharry Medical:

Good news from Meharry! The storied medical college adjacent to Fisk University in North Nashville is in the midst of a $25 million building boom, including a $1 million, phased renovation of the historic Hulda Margaret Lyttle Hall, a former dorm for Meharry's now-defunct nursing school that stood vacant and deteriorating for the past 10 years. Established in 1876, Meharry was the first medical school in the South for African Americans. Funding for renovation of the 82-year old Lyttle Hall was provided by the National Parks Service, a stimulus-enhanced grant from the American Recovery and Reinvestment Act, and private donors. For more info, visit

http://www.mmc.edu/administration/external_affairs/priorities.html

Historic Nashville, Inc. is a nonprofit that promotes the preservation of endangered properties in Nashville. Last year they identified Salemtown's Fehr School as one of the Nashville Nine most endangered historical structures.

Who needs political consultants when journalists can do the dirty work for free?

Jay Voorhees parries columnist Gail Kerr's recent swipe at Metro's services to the poor as well as her play of the race card when class was the suit laid:

It’s the last sentence that really bothered me, the one about the hospital being “money losing” and implying that the only support for the institution in by the Black Caucus. Yes, the hospital is running at a deficit this year, but it is a deficit that Rich Riebeling approved. The hospital has worked hard during the past four years to become as efficient as possible. When they mayor demanded a 10% cut in the hospital subsidy last year, the hospital informed the mayor’s office that they could not meet that target without cutting services, such as the outpatient cancer chemo clinic, which is the last line of treatment for the poor who have cancer. The mayor’s office did not want to be accused of harming poor people, so the hospital was told to leave the $1.5 million dollar deficit in the budget, and that they would deal with the shortfall later in the year through other means. This year, the hospital is in better financial shape than it’s been in for many years, however their budgeting was on the money and they are still projected to have a $1.5 million deficit, mainly because we as a city would not adequately fund the health care needs of the poor. The big problem facing the hospital, a problem that you have never addressed, is the $10 million dollars in TennCare cuts facing Metro General and the $25 million in TennCare reserves due to the hospital that are not being shared by the governor. Yeah, Metro General has huge problems ahead, but they aren’t of their own making.

As for the support for Metro General, I think the 70 plus pastors, imams, and rabbis from throughout Nashville who signed a letter of support for the hospital would be surprised to learn that the black caucus was the only supporting agency. I think the 200 folks who gathered on the steps of the Metro Courthouse would likewise be surprised, as would the members of SEIU who have a personal interest in the well being of the hospital.

Gail, Gail, Gail… it’s hard to understand why you seem to want to come after the hospital. Could it be that poor folks don’t buy your paper? Or maybe there are folks in the administration that have an ax to grind with certain community leaders who have pushed hard against the administrations ambivalence toward the need for a city supported (not run) safety net hospital, and have sold you a bill of goods.

The timing of Ms. Kerr's comment relative to upcoming budget discussions is suspicious given that a couple of months ago she bayed about former Parks Director Roy Wilson while the Mayor's Office started turning the screws leading to Mr. Wilson's December 31 exit. One wonders what Rich Riebeling has in store for this North Nashville Metro health service.

Deep Thought

When faced with the choice between believing that the pro-choice movement is a conspiracy designed by liberals bent on eugenic control of the species or that the anti-abortion movement is a conspiracy designed to maximize the flow of human bodies through the pharma-medical industrial complex in order to generate capital, the latter seems a simpler explanation than the former.

Because Everyone Knows that There Are No Crooked Medical Doctors

The Bush Administration was willing to justify torture as long as a physician was present:

According to the U.S. Department of Justice’s Office of Legal Counsel, which authored the memos, legal approval to use waterboarding, sleep deprivation and other abusive techniques pivoted on the existence of a “system of medical and psychological monitoring” of interrogations. Medical and psychological personnel were assigned to monitor interrogations and intervene to ensure that interrogators didn’t cause “serious or permanent harm” and thus violate the U.S. federal statute against torture.

The reasoning sounds almost circular. As one memo, from May 2005, put it: “The close monitoring of each detainee for any signs that he is at risk of experiencing severe physical pain reinforces the conclusion that the combined use of interrogation techniques is not intended to inflict such pain.”

In other words, as long as medically trained personnel were present and approved of the techniques being used, it was not torture.

And, after all, clinicians have never gone along with infamy before.

Thus, insuring that the medical industry will continue to dominate health care policy

President Obama has invited one of the more important lobbyists to Congress that the local health care industry has to discuss reforming America's health care system.

He won't bring home any bacon for Middle Tennessee, but I bet he does so for Big Medicine. There are indications that he's going to play ball. The question is, who owns the playground equipment?

Further Proof That a Democratic Governor in Red-State Tennessee is Irrelevant to Progress or Change

ThinkProgress considers Phil Bredesen, friend of Big Pharmaceutical, and has no love to lose.  They also link the Nashville Post blog.

UPDATE:  Bredesen's suggestion in the WSJ that he runs with the big boys can be added to the litany of hyperrealistic Bredesen postures on power relationships.

• Bredesen brought the Oilers (now Titans) to Nashville with stadium incentives like raiding $4 million in annual Metro Water funds through 2026 insisting these kinds of deals have to be made.
• Bredesen encouraged the Oilers owner to hire a local PR firm whose partner was also a former Bredesen staffer, despite the appearance of impropriety, insisting these kinds of deals have to be made.
• Bredesen brought Nissan to Middle Tennessee in sweet deal for the automaker immune from criticism insisting that these kinds of deals have to be made.
• Bredesen opened a Tennessee trade office in China in spite of the latter's ugly human rights history, of the toxic products streaming out of that country, and of the beginning of a recession that would strap the state in the coming year, insisting that these kinds of deals have to be made.

We cannot expect a politician who embraces and teases up the terrain on which political battles are fought to also be a change agent when it comes to medical coverage and care at a national level. We would be forced to continue to watch him in bed with the wealthy from afar rather than up close.


UPDATE: Foretaste things to come in a Bredesen HHS department: pharmaceuticals allowed to choose money to strip from budgets that would pay for comparative studies of effective medical treatments in order to hold down costs. Bredesen in an Obama administration would very well save the medical lobby some shoe leather in Congress.



UPDATE: Moveon.org sent out a mass e-mail today opposing Bredesen for HHS. No love lost here, either:

We need someone who's going to support visionary progressive health care reform; someone with a track record of standing up to the insurance and pharmaceutical giants at the heart of our health care crisis; someone who is 100 percent committed to giving every single American the choice of a public health insurance plan so we're not at the mercy of the private insurance companies (just as Obama promised).

Obama is reportedly considering several governors and a few senators. Many of these folks would be great, but at least one would be a bad choice for health care reform: Tennessee Governor Phil Bredesen made his fortune acquiring and running HMOs. As governor, he gutted Tennessee's public health insurance program, causing more than 320,000 people to lose their health insurance. And Bredesen let the private insurance industry pay for his multi-million dollar redecoration of the governor's mansion.

The also have a petition you can sign requesting that he position go to a progressive.


UPDATE: Ken Whitehouse describes Moveon.org's rejection of Bredesen's candidacy as "devastating blow" to Bredesen's chances.

Those Who Get Things Wrong in a Socially Acceptable Way are Not Held Accountable

I agree with Paul Krugman's criticism of Barack Obama's Surgeon General nominee and media talking head.

Being in Debt to China Makes US More Susceptable to Infectious Disease

It's taking me a while, but I've been working through Tracy Kidder's Pulitzer Prize winning book, Mountains Beyond Mountains, which calls attention to the relationship between pandemic illness, geopolitical power, and wealth.

Take a look at this passage and change the players from debtor Peru/loaner America to debtor America/loaner China:

A TB epidemic, laced with MDR, had visited New York City in the late 1980s; it had been centered in prison, homeless shelters, and public hospitals. When all the costs were totaled, various American agencies had spent about a billion dollars stanching the outbreak. Meanwhile, here in Peru, where the government made debt payments of more than a billion dollars every year to American banks and international lending institutions, experts in international TB control had deemed MDR too expensive to treat.

Given our past relationships to third-world debtor nations, there is some karma in the current US economic crisis and in our debtor stance toward China. However, we now find ourselves in the unenviable position of being exposed to dangerous infectious diseases without safety nets.

The current federal bail out is being financed by foreign countries to whom we are in debt, and the dollars are going to banks that are taking care of themselves first. So, where is the money going to be when another major MDR-type of epidemic hits our shores? China will be protecting their own; we probably will not have the disposable finances to do the same.

McCain to Slash Medicare by $1.3 Trillion

In a fit of social McDarwinism, the Republican nominee for president says that he plans to pay for his tax credit medical insurance program by cutting Medicare, the government medical insurance program for the elderly originally signed into law by LBJ in Missouri 43 years ago. Looks like John McCain is going to let some seniors fall through the health insurance safety net in order to keep the private health insurance industry healthy and a critical mass of middle-aged voters comfortable.

Obama's Challenge: Playing Catch-up to More Progressive America

While Obama's poll numbers have headed south the harder he runs to what his campaign assumes is the partisan center, a DMI study finds that middle class voters are ahead of the curve on which he lags:

Middle-class voters are split on the presidential race (about half leaning toward McCain and half to Obama) but there’s a lot of agreement around public policy with strong support for progressive measures. 75% of middle-class respondents think a universal national health insurance plan is an excellent or good idea. 71% want to see a law requiring employers to provide paid family and medical leave. 78% wish their representative in Congress had voted to expand SCHIP (health coverage for uninsured low- and middle-income kids). 68% say their rep should have voted to make it easier for people to organize labor unions. (the list goes on – check out the poll report itself).

While Democrats and folks planning to vote for Obama tended to support these policies most strongly, all the policies mentioned above get a majority of support from Republicans and McCain supporters as well.

DMI also discovers that Congress is able to vote against many progressive and popular initiatives because the elected representatives fail to communicate effectively with their constituents:

If these policies are so popular, why isn’t the nation moving in a more progressive direction? One problem is that most middle-class Americans don’t know how their members of Congress actually voted on the issues in question. While two-thirds of middle-class adults say they try to follow what Congress is doing at least somewhat closely, most get very few communications from their representatives. 72% cannot name a single piece of legislation passed by Congress in the past two years that has benefited them or their families. In part, this reflects a grim assessment of Congress’ efficacy. But it also says something about the lack of connection between the nation’s legislators and their middle-class constituents. 68% of middle-class adults would like their rep to support taxing hedge fund managers at the same rate as others in their income bracket. But 69% don’t know if that’s how their rep actually cast the vote. It’s hard to hold your representative accountable if you don’t know what they’re up to.

S-townMike as a Medical and Insurance Case Study for the Cavalcade of Capitalists

I was going through our medical bills this morning and I found $264 dollars that the Vanderbilt Medical Center charged me for a test that according to my doctor ended up being "not processed properly as ordered." No where on the bill is the $264 credited. There was also a $45 blood test that did yield results according to my MD. My insurance company credited the $309 bill $222.04 for "contractual discount," which friends in the medical profession tell me is a standard discount that insurance companies give to hospitals for supplies and service. And my MD tells me that I will need to do the test over again in the future.

Do you see the problem here? Not only is the hospital going to make a percentage of the $87.00 that they say I owe on a test that they screwed up, but the insurance company is going to count a percentage of the $222 they paid toward a total lump sum of expenses that they will use to calculate future costs to be passed along to consumers. Once I am charged a second time for the test, then both the medical and insurance entrepreneurs will be guilty of double-dipping for what will be only a single set of results. If the hospital labs screwed up the test, then the hospital should eat the loss and not pass them along to their consumers and the insurance company discount should not be paid on the charges.

But do you think that Vanderbilt Medical Center or the insurance company really care about questions of fairness when it comes to passing along future costs to consumers? I'm going to fight these overcharges for the sake of my own pocketbook, but what if this irresponsible billing occurs on a more widespread basis? Who's going to fight the societal costs of hospitals demanding payment for services not rendered?

A Stronger Antidote than Tort Reform

Tennessee's medical doctors are faced with a clear choice; join in the lemming lock step to tort-reform Texas or try something different and more ethical:

with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.

Despite some projections that disclosure would prompt a flood of lawsuits, hospitals are reporting decreases in their caseloads and savings in legal costs.

So go to Texas for the wrong reasons or stay in Tennessee for the right ones. It's the practitioner's choice.

Not-for-Profit Hospitals Made Billions in Profits over 5 Year Period

With the Metro Council debate on whether to adequately fund Metro's public hospital heating up, check out this report from Progressive States on the dramatic revenues that "not-for-profit" hospitals are making under the auspices of, well, being "not-for-profit."

Donate Your Remains to Science as Long as You Can Deal with Your Severed Head in the Back of a Tractor Trailer on An Interstate at 2 in the Morning

This grisly story about medical specimens and a police stop doesn't exactly inspire the lyrics of a traditional country song. The pulled-over truck's wipers would also have to be beating time to a broken heart somewhere for this gruesome find to be remotely close to lyrical.

Walter Reed is Military, Not VA

Associations of the horrible conditions and lack of oversight at Walter Reed Military Hospital with the Veterans Administration Hospital System are erroneous, points out Ezra Klein:

The VA system has made remarkable strides in the past decade, and is now the best hospital system in the nation, beating out such gold standard institutions as the Mayo and Cleveland Clinics. As Phil Longman writes, "A RAND Corporation study published in the The Annals of Internal Medicine concludes that the VA outperforms all other sectors of American health care in 294 measures of quality. In awarding the VA a top prize in 2006 for innovation in government, Harvard's John F. Kennedy School of Government gushed that "While the costs of healthcare continue to soar for most Americans, the VA is reducing costs, reducing errors, and becoming the model for what modern health care management and delivery should look like." The military hospitals, sadly, have not enjoyed the same rennaisance.

Some apologists for privatizing government functions are painting the problems with a broad brush across government-funded medical care in general. As has been pointed out, Walter Reed's problems seem to start with privatization; and perhaps the horrid treatment of soldiers might be traced back to the way the Department of Defense has been run for the past 6 years.