Henry J. Stern
May 10, 2007
    

The report of the Berger Commission on the closing of hospitals has come under fire in the state legislature.   Enthusiastically supported by Governor Spitzer, the Commission's recommendations have, inevitably been criticized by individuals, unions and hospitals who would be adversely affected.
 
It is generally believed that New York State's system of delivering health care is both expensive and inefficient.  Individual hospitals have grown larger over the years, adding wings and pavilions named for their donors, and using their political influence to secure state funding for expansion and construction.  Some parts of the state are oversupplied with hospital beds,, in other areas the available beds are insufficient or in the wrong type of facility.

It was the charge of the commission, established by the legislature in the Spring of 2005,  to modernize and rationalize New York State's health care delivery system by relating it to actual medical needs of the population, rather than the almost random growth which has taken place over the years. Another goal was the reduction of overlapping and costly services and edifices.  The task had to be accomplished with no significant loss in the health care services available to the public; it was no one's intent to deny acess to health care..
 
The report was generally well received on its arrival on November 28, 2006, three weeks after Election Day..  It was clearly too late to take action that year, so the thorny issue went over to the Spitzer administration and its health advisers.   Wednesday, the governor met with the legislative leaders, and at that time encountered considerable reluctance to take any action that would adversely affect anyone or anything.  The session was reported on by Nicholas Confessore on the top of B1 of the Times, TOP LEGISLATORS ASK SPITZER TO RETHINK HOSPITAL PLAN, The governor and leading lawmakers disagree on priorities. and by Jacob Gershman as the lead story in the Sun: REVOLT BREWS IN ALBANY ON HOSPITALS; Spitzer Insists He Won't Back Down.

 
You have hard of Nimby (not in my backyard), a symbol of community resistance to any new construction.   We have also mentioned Banana (build absolutely nothing anywhere near anybody).  The objection to closing any facility, no matter how ancient, inefficient or lightly used it may be, or how unnecessary it is because of the proximity of newer and better facilities is a brand of nihilistic rejectionism which deserves its own acronym.   Someday it will have one; you are invited to send in your suggestion.                                                                               
 
It is not generally known, however, that the labor cost of operating a state hospital is 30 per cent higher than operating a non-profit hospital whose employees are members of Local 1199 of the Service Employees International Union..  State hospital employees are members of other unions, and they enjoy all the privileges and perquisites of public employees: secure pensions, vacations, seniority, and a host of civil service regulations that protect  them for rigorous supervision.  They do the same work as employees in other hospitals, but the cost of their labor is substantially higher.  As one might expect, the unions representing these employees are among the most vigorous opponents of reform or consolidation.
 
It is not generally known either that the average length of a hospital stay in the United States is 4.6 days.  In New York State, the average length of a hospital stay is 6.2 days, a difference of about 35 per cent.   The length of New York State hospital stays varies by region, the shortest (5.5 days) being in upstate's central region, which includes Syracuse.  The bed reductions proposed by the Berger Commission would deal with existing excess capacity, it would not result in the shortening of necessary hospital stays.
 
The Berger Commission was created in the spring of 2005 by the legislature in connection with adopting the state budget.  It issued its report in December 2006.   The intention in creating the commission was to take politics out of hospital closing issues, similar to the Federal government's creation of a commission to close military bases in the United States which were deemed unnecessary to national defense.   The base closing decisions stood unless specifically over-ruled by Congress, which was a rarity.  If every congressman's wishes had been heeded, it would have been impossible to close any bases at all, since each facility, no matter how superfluous to the mission of protecting the United States from attack, has a network of employees, suppliers, pizzerias and other possibly less innocuous establishments across the street.
 
Everything, regardless of its utility, is a micro-economic cluster.   In order to solve the major problem of health care costs that are among the highest in the nation, the delivery system must be straightened out.   This will take a long time, and the Berger commission recommendations are just the start.   For Albany to be unable to take this initial step would indicate a level of paralysis that goes beyond what has previously been believed.
 
This is a conflict between the users and providers of health care.  The problem  is that the providers are organized and the users are not.    It would be far more efficient and productive to provide preventive care in clinics and group practices.  Hospitals are extremely expensive, even when run properly.  They are also breeding places for staphylococcus infections and other iatrogenic illnesses that kill hundreds of thousands of people each year.  That is one reason shorter stays are better than longer stays, and if your condition can be treated outside a hospital, so much the better.
 
The issues presented by the Berger report are typical of many others before the state legislature.  There is frequently a conflict between different groups, in this case a large, amorphous group of citizens who fall ill, and require hospital care, and a smaller, but better organized and consequently more influential group of employees, unions  and contractors who benefit from expenditures on bricks and mortar, and revenues from insurance, medicare and medicaid payments.

  The state, through its newly-elected governor, is attempting to change existing practices on behalf of the people, but there are other elected officials whose constituencies are narrower, and whose primary concerns are their own re-election and the preservation of the gerrymandered districts which enable their continuance in office until death or the prosecutor do them part.   These officials are content to defer to the loudest voices, regardless of the merits of an issue.   We can hope that in this difficult situation, truth and justice will prevail.  But with the prevailing cast of characters, unashamed by scandal and unmoved by reason, the closing of even the most expensive and redundant facilities will be a long slog.
 

 
#372  5.10.07  1102wds