As almost always a thoughtful observation. Thanks Rob

Excellent article, ABR. I was completely stunned and when I read about this project in the local press. I find it utterly depressing.

No one wants to check into or visit someone in a shabby old hospital. On the other hand, this trend toward hospital as Taj Mahal is ominous and does not bode well for getting a grip on relentlessly rising health costs at a time when wages are stagnant or declining and the ranks of the ensured are dwindling in spite of decades attempted health care reforms.

Swedish is a non-profit entity, just like St. James across the street from the First Hill campus. Swedish performs a service that many Christian facilities also provide. It is interesting that you didn't mention the $500 million facility that the Providence - a Catholic institution - built in Everett.

These hospitals, like the cathedrals of old Europe, survive by attracting people to their doors. Cathedrals were never about honoring God. They were about having the biggest draw for pilgrims. But the mission of those cathedrals like Notre Dame or Chartres or Canterbury were the same as the mission of today's non-profit hospitals like Swedish or Providence or Sacred Heart: improving the lives of the people they serve.

It is sad that our society has diminished faith, but don't confuse a lack of support for fancy church buildings with a lack of support for doing God's work in the world. Someone who shows up at Swedish Issaquah who is sick will be cared for, regardless of how fancy the facility itself is and regardless of their ability to pay.

The current strategy at Swedish of opening the ambulatory care centers and the new Issaquah hospital is designed to ensure that there is enough funding to continue to provide primary and specialty care at the city campuses. Swedish has a narrow margin, and the types of insurance that many of the urban patients have don't pay enough to cover the cost of their care, but by including the higher reimbursements from better insurance plans in wealthier areas there are more resources to help all of their customers.

Medical centers should be a point of civic pride in the same way that cathedrals used to be. They show a community's support for the idea of healing those who are sick. Where communities once pointed with pride to the facilities designed to save souls, they now point with pride to the facilities designed to save lives. Better for a community to be proud of a medical center than a stadium or a shopping mall. Sure, you don't need a fancy building to care for the sick, but you don't need the Vatican's priceless art collection and the Sistine Chapel to save souls, either.

Medical centers such as the one touted don't show a community's support for the idea of healing. They show the medical corporation's marketing success. That huge cathedral ceiling wasn't built for people without insurance to enjoy. However, the Mayo Clinic certainly healed a lot more people than Lourdes did.

talisker Wrote:
"Sure, you don't need a fancy building to care for the sick, but you don't need the Vatican's priceless art collection and the Sistine Chapel to save souls, either."

Non sequiter aside, thank you for confirming to all of us that healing the sick doesn't require a fancy building.

Societies build temples to the thing that is most important to them in their time.

Looking around American towns and cities you can see remnants of a time when K-12 education was the big priority. Every town has huge dominating school buildings that tower over their communities--for instance Coleman, Garfield and Franklin High schools.

Today's generation fears nothing more that their own mortality and invest great sums to build magnificent temples in a futile effort attempt to stave off death and suffering.

What is the source of the capital to build the new Swedish facility?

I also had some second thoughts as I read the original article. How will our citizens with little or no insurance be able to afford this "Wellness Center"? Does that mean private pay and insurance patients factor into the bottom line? If hospitals are our new cathedrals, does that mean that the Docs are our god? Worth some thought. Thanks Tony for stirring the pot! - Marvin Eckfeldt

Speaking of education, Peter D, our college campuses also come to mind. Two examples in particular: the Cathedral of Learning at Pitt (http://en.wikipedia.org/wiki/Cathedral_of_Learning) and our very own Suzzallo Library, especially the Graduate Reading Room (http://en.wikipedia.org/wiki/Suzzallo_Library). Both built around the same time: the late '20s-early '30s.

The new medical buildings may be imposing, and what goes on in them is certainly valuable, but architecturally I wouldn't class them as impressive--at least not in the same way some of their predecessors were. I may just have a bias toward early-20th-century and Art Deco architecture (in fact, I'm sure I have), but give me Pacific Medical Center, the original Harborview, and Swedish Cherry Hill (formerly Providence) over Swedish Issaquah any day, from the standpoint of their exteriors.

On the continued struggle to keep down skyrocketing health care costs, salaries/bonuses are an even bigger issue. Susannah Frame/King5 did a great job of highlighting the problem at a local public hospital district:

http://www.king5.com/home/valley-medical-center-122473009.html

Michael Cain, the new Swedish campus is being funded by the company that is leasing the facility to Swedish. Swedish isn't spending much capital on it from what I understand.

Yet another major triumph of form over substance. I entered the ER of a splendiferous metro hospital (named after a saint) in Kansas City for a stomach ache, and was released after 3 days of TESTS with a $30,000 bill. I had a single room with a plush sitting area, 2 LCD TV's, internet movies on demand, and gourmet restaurant food. I was shocked at how much all that luxury must be costing...whom? Hospitals, once meant to treat the sick and infirm, have been transmogrified into profit-making industries bent on enticing new customers in the glitziest way possible, just like the insurers. They assess financial before physical viability to determine how much money they can get from our 'plans'. Who can still believe we don't need drastic healthcare reform?

I'll believe these luxury hospitals are serious about serving everyone when they build one in Rainier Valley.

There's a reason why this hospital is being built in Issaquah instead of Rainier Valley and I'm sure everyone knows it: the cadillac insurance plans (and expectations of luxury) of Issaquah residents compared to those of Rainier Valley.

Hospitals which do not receive tax money don't have to provide uncompensated care. They must treat "bleeding-breathing" emergencies in their ERs but they needn't do anything else for people without insurance.

The medicalization of our society marches on. Everything is an illnes, and has a cure. The "cure" is preceeded by tests, often imaging studies that cost the most and treated with procedures and medicines that are priced to equal what the market will bear. Well, the market is just about bare and until the expectations of we the people, lower from reaching for the Taj and instead choosing integrated care that keeps people out of the hospital by early intervention and the newest technolgy not currently used much...listening to the patient and looking at the patinet... we will never reach health care reform. But we might just reach insolvency.
Mel

But do they have the expensive machine that goes "bing"?

And where would those soon-to-be Swedish/Issaquah patients have gone otherwise? To other Eastside hospitals, mostly. And are those hospitals so overcrowded that they can't wait for Swedish to alleviate their stress? Of course not. Those competitors will become less efficient once they lose those patients, which individuals and employers on the Eastside in particular will pay for. This is another example of a market behemoth who has manipulated the system to build overcapacity.
Swedish is less efficient operationally by a long shot than any of the other three Eastside hospitals, and their quality outcomes are no better. They are also paid a lot more by insurance companies than their competitors (anywhere from 15-30%), which makes no sense, and will now cost employers more for healthcare on the Eastside. Swedish is a great brand, but it is not a great hospital, at least when evaluated across a wide spectrum of objective and publicly available measures. I am not saying it is a bad hospital, but "value" is about the last word that should come to mind. They have also offered just about every doc on the Eastside a fat employment offer, which so far hasn’t really worked for them, but which is also driving up costs as others are forced to match or exceed these offers.
Re an earlier post about leasing vs capital, typically an organization only leases when it doesn't have the capital, and virtually any CFO will tell you leasing is nearly always more expensive than capital investment, and those costs get passed on to customers. Swedish isn’t leasing because it will benefit the consumer, it is doing it because it doesn’t have the balance sheet strength to invest. Heck, they're millions short of fully funding their pension obligations as it is. Just look at their audited financials.
Take the pilgrimage if you must when they open, but keep in mind the donation plate you’ll be seeing is a whole lot larger than you’re probably used to. And start to say goodbye to your locally governed and independent local Eastide hospitals, because they are probably going to have to eventually join a larger system in order to compete (and that will also cost everyone on the Eastside even more)!