Seattle Area Ballot Proposition: Harborview

Here in King County, we have Proposition #1 on our ballot to fund a bunch of modernization for a major regional hospital, Harborview. Harborview is the trauma center for four states (WA, AK, MT, and ID) and has a major burn center, as well as providing regular hospital services. It’s a major piece of the Northwest’s health infrastructure.

The two most significant local newspapers (Seattle Times and The Stranger) both endorsed Prop 1, and no one even bothered submitting an anti statement to the voter’s guide. Plus, there’s this whole pandemic going on. Even though it requires 60% of the vote to pass, it seems like it’s going to be a slam dunk.

That said, I have some misgivings. For one, it’s 1.74 billion dollars. This is for physical buildings. I haven’t seen exactly what kind of square footage we’re talking about, and I understand hospital square footage is more expensive than office space, but as a point of comparison, the largest skyscraper in Seattle, The Columbia Center, is 1.5 MM square feet and 76 stories, and it sold for $711 MM in 2015. Is this good value?

And secondly, given its regional significance, why is the entire $1.7B being borne by the residents of one county? Shouldn’t the burden be shared a bit more broadly? I don’t believe that the random citizen of Idaho should pay the same as me, given that it provides more services to Seattle than to Idaho, but it does provide some services (Level 1 Trauma) to Idaho. Why are they getting off scot-free?

Would love if another local Seattleite has a well-thought through opinion here.

Well, shit. Meant for this to go in P&E. Uh, help, mods?

Moved.

Would you prefer to live in Idaho? And any data on the number of Idahoan freeloaders? I am guessing there are not a lot of out of state folks that are level one trauma, and able to survive the flight time.

Another thing to consider is that Harborview also provides a huge chunk of unfunded public healthcare. If you don’t have insurance, it’s off to Harborview ER for your health needs. That’s a crappy way to provide healthcare but it’s better than nothing.

Hospitals are dang expensive. The Bill and Melinda Gates foundation paid for the Dolphin building at Seattle Children’s Hospital. IIRC the Dolphin Building was in the hundreds of millions along. I voted in favor despite the price tag, although I admit I read the amount twice to make sure.

I find the ownership/administration structure here hard to fathom. The facility is evidently owned by King County. But it’s not as though King County provides healthcare to its residents funded out of taxation. Healthcare is funded out of general taxation in the rest of the world, but not the U.S.

If anyone uses the facility, whether they live in King County or elsewhere, they are customers who must pay for their care (through their insurance, Medicare or whatever). So shouldn’t revenues from patient customers be the source of funding for operating the facility?

So why are local taxpayers being tapped for 1.7 billion dollars? I don’t get it. Is the facility operating at a loss from unfunded care that they want local taxpayers to make up out of property taxes?

The U.S. healthcare system is just so bizarre.

You need to build the facility, which means you need some money to build it, before you can start to use the facility. Is this proposition for a bond sale? Is the money intended as some kind of advance “loan” that the hospital will eventually pay back once it opens and revenue starts coming in?

Sure, but if there’s a viable business plan, then just like any other business that requires initial investment you can borrow money commercially to be paid back out of future revenues. This proposition explicitly says that the 1.7 billion bond will be paid back from a property tax levy on county residents.

Yes.

No. There are two things that could be ‘loans’ that are worth separating out. Private bondholders will buy King County bonds that pay off by 2040. That’s so the hospital can be built/retrofitted now. They will be paid back by funds raised from property taxes. Secondly, there is the money that the taxpayers of King County could be ‘lending’ to the hospital. That’s a misunderstanding. There is no loan there. Taxpayers won’t be paid back. The hospital, presumably, cannot pay back its capital debt out of its operations.

Sure, as I stated in my OP, I’m well aware that the capital costs are going to be higher than with regular office space. But unless you have some quantification on this, I have nothing other than a gut feel on whether or not its good value. It’s frustrating to me that the pro- campaign doesn’t feel the need to make the case here. There’s no way that any citizen can make an intelligent decision here with the data as presented, and 99% of folks aren’t going to dig further than the newspapers and the voters’ guide.

Sure, I know. But that’s still true if you live in Lynnwood, right?* Why don’t Snohomish county taxpayers chip in, too?

*I will confess ignorance here. Maybe the hospital where public healthcare is provided changes at the county line, but Lynnwood is a lot closer to Harborview than, say, Enumclaw.