Joseph M. Nixon isn’t sure which senator got $100 million for a new hospital in his or her state, but the circumstantial evidence points to one state: Vermont. It is probably a sign of how late in the day the $100 million got added that there wasn’t a chance to think of a clever way to describe a state that could only be Vermont (“a state that borders Canada and has a population density of between 65 and 70 residents per square mile”) without saying “just give it to Vermont.” But rather than say “Vermont,” the provision, Sec. 10502 of Senator Reid’s manager’s amendment says $100 million goes to a state with a teaching hospital attached to a medical school that happens to be the only public medical school in the state. There are other states that meet this definition, but the money is available only in fiscal year 2010, and that probably makes construction of a new hospital for Fletcher Allen, the primary teaching hospital for the University of Vermont Medical School, the only project that qualifies.
Vermont’s medical school has been looking for money to build a new hospital. The 2008 annual report for Fletcher Allen includes an interview with the health system’s CEO in which she says, “The centerpiece of long-range facility plans for the organization is building new inpatient capacity.”
Another bit of circumstantial evidence: The provision appears just before a provision for which Vermont’s Sen. Bernie Sanders has taken credit, a pot of money for community health centers and a federal program that puts doctors in places where there doctors are scarce.
The $100 million line item for a hospital is less than 1 percent of the total cash that Senator Sanders got to go along with the Senate majority leader’s game plan. While the ink and media time has gone to Sens. Ben Nelson and Joe Lieberman, more cash went to Sanders. Political science, not ideology, explains what is going on. When one vote makes a supermajority, any senator who can make the credible threat that he or she won’t go can hold out for more. Sanders, like Lieberman, is an independent who caucuses with the Democrats. Sanders, cranky and unpredictable, urged by his state’s former governor, Howard Dean, not to vote for the bill, could make a credible threat to vote no.
Dollarwise, the amount that Sanders got exceeds what Sen. Ben Nelson got for Nebraska or any other senator got for a Medicaid formula fix. Senator Sanders got $11 billion for community health centers and the National Health Service Corps, a mechanism to pay for doctors to work in places or serve people who can get the label of “underserved.” Sanders got $11 billion, but clearly hopes for more. The additional money for health centers, meant as an addition to the $2.1 billion they got last year, starts at $700 million for 2011, then ramps up to $2.9 billion for 2016, and then goes to zero. Or will it? The centers that get the $2.9 billion in 2016 will surely make the case that calamity will follow if the extra money dries up.
It took a lot of money for Senate majority leader Harry Reid to reach the 60 votes needed to avoid dealing with Senate Republicans. It would be nice if the attention paid to how he did it was proportional to the dollars he promised.
– Hanns Kuttner is a visiting fellow at Hudson Institute.