Bill de Blasio, a top-tier mayoral candidate, promises to drag New York City hospital care from the dark ages into the daylight. But everywhere he goes, the health-care workers union is bobbing along behind him, waving supportive signs and shouting down the opposition.
So it makes a person wonder: When it comes to hospital reform, does de Blasio really mean it?
Lefty actresses — hi, Cynthia Nixon and Susan Sarandon — just love Bill to death on hospitals. And then there was a protesting de Blasio in handcuffs — how retro! — in front of Brooklyn’s bankrupt Long Island College Hospital earlier this summer.
But neither the fading actresses nor that comically orchestrated arrest begin to address the stark fact that, when it comes to hospitals, Bill de Blasio seems to be very much on the wrong side of history.
Actually, he’s on the wrong side of ObamaCare, too.
The tipoff is the health-care workers union. Local 1199, SEIU, has two basic goals this political season — electing de Blasio mayor, and keeping fiscally decrepit, fatally inefficient hospitals open.
In that respect, Local 1199 is very much akin to the United Federation of Teachers — the political behemoth that never met a failed public school it wouldn’t go to the mattresses for, no matter how many kids’ lives are at stake.
For both unions, the bottom line is jobs, members and the dues they pay — not effective health care, nor keeping kids on course to compete in the global economy.
And, for both unions, the fundamentals are the same: Exploit the fears of often unsophisticated people who don’t understand that piles of brick and mortar once got the job done, but no more, and that while there are no easy answers, there are indeed better ways.
Fewer hospital beds, yes — but more preventive care, more outpatient clinics and more professional aftercare. For starters.
It’s been almost 40 years since then-Gov. Hugh Carey made the convincing case that a chief driver of heath-care spending was a dramatic oversupply of hospital beds — that, indeed, hospital administrators were keeping their institutions solvent by admitting vast numbers of patients who didn’t need hospitalization, and by keeping those who did need it far longer than was necessary.
The then-standard fee-for-service insurance system all but mandated such profligacy — just as it did the use of ultra-sophisticated, super-expensive emergency rooms for delivery of basic primary-care services.
Got a tummy ache? Here’s an MRI, and we’ll send the bill to Blue Cross, or Medicaid.
But the gap between Carey’s diagnosis and a solution was vast. A commission chaired by former Carey aide Stephen Berger found six years ago that the city still had far more hospital beds than it needed, or could support, and that ERs were still delivering primary care at vastly inflated prices.
Such conditions couldn’t last, and didn’t.
New federal, state and local laws and regulations — soon to include ObamaCare, with a vengeance — are vaporizing the financial incentives for unneeded and extended hospitalizations, for example. Hospitals are now sharply penalized for such practices.
The changes have slashed patient populations — and so pushed many financially marginal institutions straight over the edge. (See above, Long Island College Hospital.)
Meanwhile, both the government and insurers have been heavily incentivizing “wellness initiatives” — quit-smoking and diet programs and so on — meant to dramatically cut hospitals out of the picture.
All this is having the intended effect. Emblem Health, city government’s main health-insurance provider, just delivered a whopping $363 million premium savings to taxpayers — in no small measure thanks to its wellness programs.
There’s a lot going on, of course, but Emblem’s experience is instructive. Between the hospital-admission disincentives and its wellness programs, the insurer saw a 43 percent drop in days hospitalized (an esoteric industry metric) in its last rating period.
The result: dramatic premium savings.
And, to the chagrin of Local 1199, fewer hospital jobs, too.
This is no small thing in its own right. Adjusting to the new realities will be a wrenching process, and all involved are obliged to make it as humane as possible.
But the alternative — unplanned catastrophic bankruptcies —will be even more painful, with more jobs lost, and with more lives placed at unnecessary risk.
Bill de Blasio, isn’t the only Democratic candidate to be demagoguing this issue. To their shame, they all are. But Local 1199 is backing de Blasio with great vigor. Clearly, he’s their featherbedder of choice. So, that matters.
No one expects the actresses to know better, but everybody should expect more from a man who would be mayor.
Pity they’re not getting it.