Harming Patients and Taxpayers

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daily beastFor years, 1199SEIU has prioritized health care jobs over the health care needs of patients. Due to its political muscle, politicians in New York are hesitant to cross the union – and taxpayers are paying the price. As a result of 1199SEIU’s power, New York has more hospitals than it needs, Medicaid costs have skyrocketed, and the sick and elderly have fewer options for avoiding institutionalization. Furthermore, although New York spends more money per capita on health care than any other state, the state’s quality of health care is significantly less than first-rate.

According to the Kaiser Family Foundation, New York State spent $54 billion on Medicaid in 2013, more than one-third of the state budget and the second-highest amount among the states (after California, which has nearly twice as many people).

New York spends more on Medicaid than Texas and Florida combined. The state spends so much because it enrolls so many people—6.2 million today, up from 2.7 million in 1995, during a period of near-stagnant population growth—and because it allocates Medicaid dollars using complex reimbursement formulas that favor inpatient hospitals and nursing homes—more expensive modes of health-care delivery than outpatient clinics and home care.

Favoring hospitals and nursing homes tends to favor health-care providers—including 1199 members—over patients. The goal of health-care policy should be to make people healthier, but the high price tag of New York’s health-care system has never correlated with its performance. New York ranks 19th in the nation in the quality of care, according to the Commonwealth Fund, though it spends more on a per-capita basis than any other state.

In all of its health-care policy advocacy, 1199 has held to the position that what’s good for union members is good for the public. As one issue of its monthly newsletter put it, “Saving our hospitals isn’t just about jobs, but also about healthcare for the people.” But while making health-care jobs some of the most stable and secure in New York, 1199’s advocacy efforts helped create and perpetuate an overly expensive and inefficient health-care system.

Indeed, over the last two decades, 1199 has perfected a brand of politics that allows the union to get most or all of what it wants from New York governors—either by entering into mutually beneficial alliances or by organizing to quash reform plans that might be adverse to its members…

One of 1199’s most celebrated victories came in 1999, when an extraordinary $13 million lobbying campaign persuaded lawmakers to spend over $1 billion to expand Medicaid through a program called Family Health Plus, which would extend coverage to 600,000 previously uninsured adults. The union paid its lobbying bill by redirecting money from the 1199 pension fund…

To date, then, 1199 has achieved most of its ends when it comes to health-care policy. But the union remains focused on the continuing threat of hospital closings and consolidations, which got under way after the Berger Commission, appointed by Pataki near the end of his tenure, issued a report critical of “excess capacity” in New York’s health-care delivery. The commission found that the statewide hospital-bed occupancy rate was 83 percent in 1983 and just 65 percent in 2004 and that most nursing homes operate at a loss. This problem has led to gross inefficiency and endangered the quality of care. Insolvent hospitals can’t reinvest in equipment and staff, and a system with too many hospitals disperses expertise. The commission recommended closing nine facilities and downsizing dozens more across the state. The issue is particularly acute in New York City, where eight hospitals have closed since 2007. According to a 2011 report, “[a]lmost 30 percent of Brooklyn’s hospital beds are vacant on an average day.”