Sunday, March 11, 2007

Health wars

Newsday Editorial

Newsday is right on target........reform needs to be started and compromise is the order of the day....but as any savvy union negotiator realizes........ask for more..than you can reasonably expect..this way.when you compromise..you have actually attained your goal......to borrow a Mondello quote....Spitzer's Momma didn't raise a dummy..........andy

Spitzer's proposed cuts spark protests by health workers throughout state The mighty armies of the state's health care industry, an alliance among its hospitals and labor unions, have never found an opponent with the will and wherewithal to fight them on the battlefield of funding. Never, until now.Gov. Eliot Spitzer is fighting to cut more than a billion dollars from Medi-caid and to dramatically reshape not only this huge program for the poor and disabled but the state's entire system of delivering health care for everybody.It's a case worth making, a fight worth waging - for taxpayers, patients and the hospitals and health care workers themselves. This page has concerns and questions about the depth and pace of the cuts this year and about some details of Spitzer's broader plan, but he is right that fundamental reform must start now.Spitzer's worthy goal of dramatically expanding access to care for more than a million uninsured New Yorkers - which would be good for patients and providers alike - can only happen if every effort is made to squeeze every cent of waste, fraud and abuse from an inefficient system.And slowing the growth of Medicaid, particularly by reducing a heavy reliance on expensive hospitals for care, is inarguably essential. Even with 50 percent of the funding coming from Washington, and the clever leveraging of federal dollars to pay for state and local programs, New York's taxpayers can't afford Medicaid cost increases at double and triple the rate of inflation. Even with all the good the program does, as an economic engine and social safety net, such a growth rate is unsustainable.A health juggernautWhen it comes to the state's Medicaid program, the health-care lobby has largely had its way - especially with lawmakers. No governor has withstood the industry's emotional appeals and political influence, fueled by tens of millions of dollars in advertising and tens of thousands of foot soldiers working in campaigns all over the state. But nobody can deny Spitzer's central point: New York spends more than the next two states combined. That is neither acceptable nor sustainable.

This year, finally, that lobby has found a worthy and well-armed adversary: Spitzer not only is spending a great deal of his political capital to defend cuts to hospitals and nursing homes, which have strong support within their communities, but millions of dollars from his own campaign kitty to make his case.This page does have some concerns about aspects of this year's health wars - beyond the increasingly contentious tone of the ads and statements being blasted back and forth (at $1 million a week) like an artillery duel.How much cutting is too much?

We have questions about the size of the cuts - more than $1 billion - that Spitzer has proposed for hospitals and nursing homes, many of which already are experiencing financial distress that might only be solved by squeezing more services for patients and residents. The proposed reductions overall represent less than 1 percent of their revenues, but it's fair to ask whether institutions with the nation's smallest profit margins - many struggling in red ink - can absorb even that big a hit in a single year.Nassau University Medical Center, which has been making progress in tackling its chronic deficits and care deficiencies, would go from losing money to losing more money. How would that help its current comeback or its mission to serve the poor?Will freezing an annual cost-of-living increase in state funding at NUMC and others mean staffing cuts that hurt patient care? Will it mean less money, not just for the high-paid executives Spitzer has gratuitously attacked, but for keeping the wards clean and refurbishing or replacing outdated facilities?It's also fair to ask whether it's wise or fair to squeeze $1 billion or more from hospitals and nursing homes in the same year that President George W. Bush is proposing ever deeper cuts in Medicaid and Medicare - and only months after the Berger Commission recommended, and Albany approved, the closing or shrinking of dozens of hospitals and the loss of thousands of beds. Are those contractions too much for the state's health care system to absorb, at least in one year, without jolting it further with state and federal spending cuts?

Outright spending reductions, as well as systemic reforms,are absolutely necessary for a Medicaid system that spends far more than any other state - especially in hospitals and nursing homes - and gobbles up a large chunk of the state's overall budget. But would it be wiser to spread out the cuts - and the many admirable reforms in Spitzer's broader plan - over several years and to focus more on other facets of Medicaid, such as soaring prescription drug and long-term care costs?Should taxes on health insurance companies be increased to force them to pay a greater share of the cost of health care in the state, which produces substantial profits for HMOs and other insurers?

These are among the many questions that the governor and the legislature must settle fast, if they are to pass a budget by April 1 and begin the process of reforming the $100 million health system. The governor knows how deeply tied lawmakers are to the health-care industry. He's rightly concerned that delay in cutting or implementing change will play into the industry's tactics to protect an unacceptable status quo. He knows a new governor has a limited time to get a few big things done - and there's nothing bigger or more crucial than reining in costs for overburdened taxpayers and improving care for millions of poor, disabled and elderly.Compromise on details, not reformSo Spitzer should be ready to compromise, but only on the immediate hit to hospitals and nursing homes and only in exchange for a commitment to reach his fiscal and policy goals over a slightly longer period. Not on the principle of reform. His goals are right on. Unlike other efforts to cut Medicaid, particularly by Gov. George Pataki, Spitzer does not try to limit services for patients or increase co-payments and deductibles. He should be applauded for that and for his desire to have Medicaid dollars pay for Medi-caid services - and not use the program to subsidize other health care programs.Spitzer also understands that more and more care must be shifted from expensive hospitals to the community, such as in clinics and in homes. And he knows that a focus on preventive care can head off health problems that will be far more expensive down the road.The battle is joined. His agenda is ambitious and long-term. Even if he has to give a little ground this year, Spitzer must use his clout and leadership skills to start the legislature and the health- care industry toward real reform.
Copyright 2007 Newsday

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