Health Care Done Right

There’s been more heat than light lately over the discussion the Metro Council is having about whether they should have some role in planning health care facilities in the region. Metro hasn’t made a decision yet, and if they get involved, I suspect it will be a fairly light touch, but a lot of people are getting worked up about the idea.

So I was struck by the article in the O last week about the new Portland Clinic at Gateway. This is exactly what Metro should be trying to promote: a health care facility in a regional center, well served by transit and other modes of transportation. Reinforcing centers instead of competing with them!

Contrast that with a new hospital in Happy Valley that one local health system wants to build. Can anyone tell me how they would get to Happy Valley (either by transit or road)? I’d have to pull out a map…

10 responses to “Health Care Done Right”

  1. It is interesting that this subject is brought up in an effort to tie it to alternate mode like transit. These are two different examples that tell to different things.

    In expanding new health care facilities off of Sunnyside Road and the Clackamas and Happy Valley area what we find is that Kasier and Providence are building new facilities where the people are moving too, that was under-represented with health care options.

    They are both doing what other businesses should be doing and that is locating there activities to where many of their people and patients live.

    This is trend that we see of people and businesses moving out of Portland to a better suburban quality of life and family scenario.

    Thousands of employees and patients will not have to clog Portland roads and highways to get health care excellent health care.

    The Gateway Transit Center Medical Redevelopment Complex and Parking Garage is to all affect, TIF funded off the backs of all of the citizens not included in one of the boundaries of one of the 11 TIF/UR Districts in PDC’s Portland districts.

    This is again a case where government not private enterprise development is being used to build additional use and justification for LRT/MAX systems. It would be nice for the public to know all of the finances, grants and tax abatement that were used?

    The question is how many patients and employees of the Portland Clinic will come and go from this new facility via public transit methods.

    As an example will 50% of the employees use LRT/MAX for greater then 90% of their incidents of travel to the Portland Clinic or will it be 30% of the employees using LRT/MAX for 30% of the incidents of travel to the Portland Clinic???

    Who will pay for or subsidize any of the transit fares to this Portland Clinic at Gateway?

    Is the Portland Clinic opportunistic in getting out of core Portland and also moving out to where the people were under-represented with quality medical care options?

    It could well be an opportunity that they just could not refuse coming out of the TIF world. Doctors are not dumb if you are going to give them money off the back of a lot of citizens why not take it.

    Remember Portland Clinic probably will not contribute one dollar in tax to fund all of the increases and needs for greater public services.

    Some of this will be paid for by seniors on fixed income who are desparately trying to hold on to their homes and live out their lives many on Social Security with added property tax burdens to cover what Portland Clinic will not be paying.

    Oh, seniors use LRT with a lessor percentage then the general public, this will have a lessor benefit to them. At the same time senior are the biggest users and have the greatest need for facilities like the Portland Clinic.

  2. I’m unclear on what exactly Metro’s involvement would be in health care in the region. Would it be zoning and planning for health care centers in the regional and subregional hubs? Or something more?

    This seems like a no-brainer to me. People need good transit access to health care facilities. The elderly, the disabled, children and those without cars need to be able to get to doctor’s appointments and take care of other medical needs, without spending hours doing so. Ensuring that there is access to health care near every neighborhood would seem to be just one more ingredient in a successful regional planning program.

  3. Urban Renewal Districts are created under State statues by Portland City Council. They are of limited duration and have fixed maximum bonding levels. Typically they are created to help fund regionally significant/valuable projects like Waterfront Park, Pioneer Square, MAX Yellow Line and to focus public investment in defined areas in the expectation that this will stimulate private sector investment, so that at the end of the URA the taxable value of property will be greatly enhanced. During the life of a URA the amount of property taxes collected in the “base year” continue to go to the various jurisdictions…city, county, schools. It is the increase above the base year…the tax incretment…that is used to pay off bonds that pay for public investments. Every URA is different, but much of what you see and enjoy in the way of public investment in downtown was paid for in this way.

  4. To Garlynn’s question. Metro staff is preparing a set of options for the Council to consider. My understanding is that they range from ‘do nothing’, to acting as a convener of some kind of regional group (providers, stakeholders, etc.) with Metro having no direct role other than convener, to some kind of input into siting decisions. At the extreme end (which I don’t think anyone expects to happen), Metro would have it’s own ‘certificate of need’ type process. Again, that one’s not going to happen.

    I personally think Metro could add value as a convener, but I would like to see some level of coordination between health care siting and the regional functional plan (2040). That coordination need not be regulatory (i.e., could be voluntary) but it seems like at least having a place to examine and talk about the interactions is valuable.

  5. Paul, there are a number of points in your comment, so let me deconstruct it a little bit. We’ve had the ‘finance’ (TIF, etc.) discussion before and I think we both agree it’s broken, even if we disagree on some details, so I won’t go through that again.

    But it seems to me that what I hear you consistently arguing, and again in this comment, is that we are constrained on mobility. We need more capacity to get from here to there.

    I tend to turn that on its head and say we need better access. We should be able to get to jobs, services and recreation with LESS travel. That’s the whole point the Centers component of 2040. By locating jobs, housing and services in compact centers, we get the access with less mobility. Putting a hospital in Happy Valley may be following customers (particularly those with generous insurance coverage), but it requires more mobility. Puting a clinic in a Center has the potential to lower the requirements for mobility while increasing access.

    I would also note that this is not about ‘leaving Portland’. The Portland Clinic is not shutting down its Portland facilities, it’s adding new ones. The Centers idea anticipates this, it’s not about getting everyone to go to Portland for their services, it’s about finding those services closer to where you live.

  6. Lenny, What you said is right but it does not tell the whole story in around TIF/UR Districts.

    There is a very big Clackamas County UR Dsitrict of the Clackamas Town Center. When it was established there was a base year for total assessed tax value for all property within its boundary.

    Wonderful thing happen and we have a great big Clackamas Center get built. All of these new building are not and were not in the “Base Year” assessed tax values.

    Now there are new responsiblities now for the Clackamas County Fire District #1 to provide fire protection to all of the new building and people within the boundary of the the Clackamas Town Center Development/UR District.

    How much NEW funding does the CCFD #1 get to pay for their NEW obligations and responsiblities to provide infrastructure, people and services for this UR District, the answer is ZERO!

    So where does the funding come from, just guess!

    Chris, it is not about Portland Clinic locating at this location because it is great. If it provides additional opportunities for people to get and receive medical care without having to use a car that is wonderful and smart for Portland Clinic and our environment.

    If this was a total free enterprise funded activity, I would have been telling everyone that there were good and smart doctors making this happen.

    Sometimes we need to trust that responsible people and businesses will do the right thing without government assistance and special interest give-a-ways.

  7. It seems to me planning health care facilities is more of a county role, not Metro’s role. If Metro does take on even a light touch role, then why not also a role in locating fire stations, libraries and even public toilets. All are related to transportation planning and everybody has an occasion to use a public rest room.

    A case in point involving the library system is the Hollywood Branch Library built with funds from the last library levy. The main entrance is located at NE 41st and Tillamook Street. From strictly a public transportation standpoint, a better location would have been on the South side of Sandy Boulevard near the Hollywood Max Station. Where it was built probably works better for the Hollywood Neighborhood and people driving to the library. So the question remains; would a location closer to Max and the same distance from Sandy be better a better location for all the adjoining neighborhood residents who also use the Hollywood Branch Library?

    I do not believe this is Metro’s responsibility or their turf to tell other entities where to locate facilities.

  8. One other thought that came up just as I hit the send button:

    Do we as a society really want a lot of sick people infecting others by riding public transit?

  9. What’s the big deal?

    Most hospitals are easily accessible by some form of transit (yes, even a lowly, pathetic BUS).

    Tuality Hospital (in Hillsboro) and St. Vincent Hospital (in Cedar Hills) both have semi-close access to MAX (St. V, by way of a hospital operated shuttle bus; also TriMet 20/Burnside-Stark.)

    Don’t get me started on the who-knows-how-many busses that go to the V.A. Hospital and OHSU, including all those 60X series express busses.

    It’s great that a business desires to build close to a transit center; but business has an obligation to build where the demand is. Sick people don’t want to wait 15-30-45-60 minutes for a bus to take them somewhere else, they want something close by. (Ironically, there is a hospital that is about three miles away from my home – but to get there by bus would take me a minimum of an hour. Thank you, TriMet, for having no transportation options to get me from one end of Tualatin to the other end.)

  10. Let me respond to a number of points:

    – Siting a fire station is not a transportation issue, they don’t generate very many trips (a dry cleaner probably generates a couple of orders of magnitude more trips), it’s mostly a safety issue about how fast you can reach points in the service area.

    – Siting a library is clearly a local function, because branch libraries serve a local area. And the Hollywood library is ‘correctly’ sited by Metro’s lights because it’s in a town center. Where in the town center it should go is a matter for local zoning. Metro does NOT try to do zoning, it sets a high-level functional plan for the region, local jurisdictions have to zone in a way that conforms to the high-level plan, but they own the local decisions.

    – Siting a major health care facility DOES have regional implications, because a significant portion of the trips will be regional, crossing county boundaries. Making Centers happen requires aligning patterns of investment, and health care facilities are major investments. I think Metro has a legitimate interest for facilities at this scale (just as they would care where another shopping center the size of Washington Square got sited).

    – Most people who travel to health care facilities are not infectious. I think that’s a red herring. Anybody who is infectious should take care not to expose other people no matter what mode they use.

    – It’s not just about transit. Putting a health care facility in a Center also means that people driving to it are likely to travel shorter distances on average.

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