Public health just as essential as police, firefighters, clean water. Let’s value it equally
Despite policy and technological innovation occurring nationwide, what I like to call “Healthcare Nirvana”—better outcomes, cost effectiveness and health equity—remains unrealized. It is time to invest in a better healthcare future for all.
NYC Health & Hospitals is a key tool for making that investment in New York. We are proud to partner with Mayor Bill de Blasio on a comprehensive transformation plan to secure financial stability. NYC Health & Hospitals, like other public healthcare delivery systems across the nation, safeguards health, a benefit as essential as public safety, firefighting and clean water, and one that should be valued the same way.
A report recently published by New York’s Independent Budget Office reached two conclusions about our transformation plan: Reviving our fiscal health will require cooperation from federal and state government and labor; but success is uncertain. With all due respect, those of us working in the trenches to strengthen the public healthcare system already knew this.
The IBO’s report emphasizes our deficit, but is flawed by omission, offering no context for the reasons behind shortfalls, and no alternative to the transformation we have embarked on. They seem to be saying: Your plan will be hard to accomplish, better not attempt it. It’s a good thing they weren’t advising Gen. Eisenhower before D-Day.
Let’s be clear: Public healthcare in New York and elsewhere delivers much care without getting paid for it. Critics suggesting the New York system is losing money are wrong. Despite our gratitude for increased city funding, we are like a family station wagon that everyone uses, but no one gases up.
One in six New Yorkers accesses our comprehensive services. We provide 1.1 million ER visits, 4.2 million clinic visits, and 45% of behavioral healthcare occurring annually.
Our deficit is due to basic economics: low Medicaid reimbursement, unfair methodology for distribution of state charity care, and evisceration of payments to compensate us for care provided to patients who cannot pay.
This last point is significant. Modern Healthcare recently shined a spotlight on disappearing disproportionate-share dollars—huge reductions baked into the Affordable Care Act on the assumption that wider insurance coverage would lessen the need for federal funding. It hasn’t yet worked out that way. Uncertainty in new marketplaces, exclusion of the undocumented, and refusal of many states to expand Medicaid, means the uncompensated care burden for public systems across the country hasn’t declined. Adding insult to injury, the CMS has proposed a new DSH formula rule that will further disadvantage us. Of course the impact of changes in federal policy isn’t exclusive to New York. They pose fiscal challenges to public hospital systems nationwide.
Our deficit didn’t result from unnecessary spending. We don’t have celebrity wings, valet parking or atrium grand pianos. Nor is it a result of mismanagement. We are regularly cited by leading journalism/advocacy organizations for quality and safety excellence. We’re at the forefront of reforms to improve care and save healthcare dollars.
The IBO’s report does a disservice by offering no alternative to our aim to avoid eliminating services, or our reliance on efficiencies, growth and government support. Sure, generating revenue is harder than cutting, but if public hospitals cut, where will people go for care? What would a day without us look like? How many troubled individuals would wander the streets? How many would perish from hypothermia in winter? How many wouldn’t make it through traffic to distant ERs?
Whether it’s victims of gun violence in our trauma departments, patients made ill from street drugs presenting in our ERs, or patients who’ve visited countries grappling with epidemics like Zika or Ebola being screened by our infectiousdisease specialists, if there’s a health emergency, public hospitals across the country step up. And we do so despite the lack of reimbursement streams for such care.
Without a robust public system here in New York, achieving health equity is less likely. We will move closer to a Tale of Two Cities, one rich and healthy, the other poor and sick. New York has always rejected that path, standing instead for the idea that health is a human right. These are times to deepen—rather than doubt— that commitment.
Dr. Ram Raju is president and CEO of NYC Health & Hospitals.