New York State’s “Commission on Health Care in the 21st Century” has called for closing at least nine hospitals, which, with further forced mergers and downsizing, would reduce hospital beds by 4,200 statewide. Another 3,000 nursing home beds would be lost. The wholesale reorganization and consolidations would have additional far-reaching consequences.
The commission started with an assumption that there are 20,000 excess hospital beds statewide, but its cuts and closings would translate into greater difficulty getting to inferior care. There would be longer ambulance rides and emergency room waits, earlier deaths, more suffering, and more ill people in the state.
Many elected officials, community and union leaders, and health care professionals have expressed concern about the impact of decreased availability of health care services, particularly in already under-served African American, Latino, immigrant, working-class and other poor communities.
Health care is an important industry in New York; the job losses will have serious, negative economic and social effects in many towns and cities.
In addition, some of the proposed mergers would combine public with private hospitals, including Catholic hospitals, thereby heightening the pace of privatization and possibly adding restrictions on women’s health choices.
Serious job loss
Although hospital cuts and closings will mean jobs lost and worse conditions of employment for thousands of members, Service Employees Local 1199 has not spoken out in opposition. The union represents 275,000 health care workers in the state. Some 1199 members and staff indicated that the union’s leadership does oppose these cutbacks but feels that impending budget cuts are an even greater threat. They say that budget cuts could mean up to 25,000 jobs lost, and the union’s limited resources should go into that struggle.
Both Republican Gov. George Pataki and Democrat Governor-elect Eliot Spitzer support the report’s proposals. Pataki’s endorsement of his commission’s report was necessary for the cuts to move ahead. He issued his endorsement from Kuwait, on a stopover after three days in Iraq. Apparently his lackluster presidential campaign needs to claim more cuts in people’s needs to increase support from right-wing Republicans.
Gov.-elect Spitzer does not take office until the Jan. 1 and has no direct involvement in the proceedings. However, he campaigned for cutting Medicaid costs, and says he wants the all-or-nothing cuts to become law, adding that even more cuts may be needed.
The way the commission’s report is being implemented raises substantial legal issues. The cuts automatically go into effect at the end of this year unless both the New York State Senate and Assembly have rejected it. But rejection would result in loss of $1.5 billion in federal health care funds. At this point, Pataki’s appointed 18-member commission wields more power than the New York Legislature. The elected representatives of the people can neither amend the report nor modify its implementation. It seems likely that at least one judge will find a violation of the U.S. or New York State constitutions.
The commission’s methodology exposes a bias toward cuts in health care. The main premise of the report — that the state has an excess of 20,000 hospital beds — is unsupported.
Any real plan to stabilize and strengthen New York’s health care system would begin with an in-depth evaluation of the health care needs of the state’s people, both met and unmet. Then it would proceed to propose ways to improve and expand services to better meet those needs.
What about national health care?
National health care programs exist in practically every industrialized country in the world. But by omission of any mention of this alternative in its press releases or the report’s executive summary, the commission bases its proposals on the unspoken assumption that a national health care program should not or will not be enacted in this country. Given the growing support for the Conyers bill, which will be introduced in the new Congress, this is shortsighted at best.
Pataki’s Commission on Health Care in the 21st Century is better known as the “Berger Commission,” after its chair, investment banker Stephen Berger. Berger was Gov. Hugh Carey’s director of the emergency Financial Control Board during the city’s mid-70s budget crisis. He led the efforts to put the burden of New York City’s fiscal crisis on public workers and city residents. Choosing such a fiscal tough guy to do a hatchet job on the state’s health care is not much of a stretch.
bdavis @ cpusa.org