Friday, December 15, 2006

ALBANY AGENDA: A cure for health care Spitzer must improve NY's system even as he scales back its cost

Newsday Editorial

Nobody ever said this was going to be easy............andy

Gov.-elect Eliot Spitzer said it himself: "Our state's broken health care system requires drastic reform." His critical challenge, especially for millions of New Yorkers who can't afford care without government help, is how to rein in the cost of the nation's most expensive collection of state health services without reducing its quality.This challenge will be all the more difficult because of two potentially colliding pledges Spitzer made during his winning campaign: He would actually improve care and expand access.

Yet, he would pay for this and other priorities, such as cutting property taxes and boosting school aid, by slashing billions of dollars from health programs.Change won't come easily. Given the power of the health-care lobby and its sway over the State Legislature, it will take a tough, shrewd and smart politician to get it done. But New York can't afford to go on spending 30 percent of its budget on Medicaid alone - far more money than California and Texas combined - while this program for the poor, disabled and elderly, and other parts of the health system, remain so inefficient. And Spitzer, along with supporters and opponents of sweeping change, knows where to attack the problem in the public and private sectors - the troubling trio of waste, fraud and abuse.

Here are some of our priorities:Hire a great health czar. Much of Spitzer's challenge will be to manage change already in the works, including the Berger commission's landmark plan to close or combine inefficient hospitals and nursing homes. He will need a strong team: Change will involve a number of agencies, from the health department to the new Medicaid inspector general, and it must be coordinated by a respected expert as health commissioner.Berger must be just a beginning. Closing 40 hospitals and nursing homes and merging dozens of others, to which the state is now committed, demands careful administrative and political attention. But in a state that spends far more than any other on hospital stays - and gets no better care - simply closing institutions won't be enough. What's needed is a seismic shift of attitude and focus to keep patients out of nursing homes and in more "community-based" settings. The biggest potential savings, at least for the state budget, is in Medicaid. And forcing medical institutions to be more efficient will help.

But Albany must do more to make this safety net for one in five New Yorkers more efficient for them and taxpayers alike:Subsidize nursing care only for the real poor. More than 70 percent of the state's Medicaid costs go to 30 percent of the patients - the elderly and disabled in nursing care. But many of them either have transferred assets to their families, or their spouse has refused to pay for care - practices barred in many states as merely inheritance protection. Instead, Spitzer should offer incentives to buy long-term care insurance and find ways to keep patients in their homes longer.Reduce prescription drug costs. Spitzer must ensure that the drug lobby doesn't thwart ongoing efforts to create a preferred-drug list that requires the use of less costly generic medicines. To help patients, as well as to reduce costs, he also must push for new technology to better track the use and effectiveness of drugs. Manage care for more patients. Spitzer can't let New York lag behind many states in enrolling Medicaid patients in privately run managed care. It especially should no longer "carve out" so many - the elderly, disabled and addicted - from better, cheaper treatment.Even if bloated, many of these programs are important, popular and backed by powerful interests. Spitzer should spend as much of his political capital as necessary to bring them down to size.

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