Morning Read: The public debate over public health

As the discussion over providing health care programs, and long-term care for low-income seniors, moves forward in the North Country, concerns are being raised over the way those conversations are taking place.

Even some supporters of the move to privatize Horace Nye nursing home in Elizabethtown were bothered by the lack of a public hearing to take comments on the plan.  (Sale of the home passed on a 12-6 vote on Tuesday.)

Meanwhile, North Elba town suprvisor Roby Politi says he wasn’t briefed about a plan by the non-profit company Adirondack Health to downsize by 50% the number of nursing home beds in Lake Placid.

“We will certainly continue to monitor via the [NYS] Department of Health what they’re planning on doing and hopefully we’ll be part of the discussion,” Politi said yesterday.

(Adirondack Health spokesman Joe Riccio says talks with local leaders will take place as the planning process moves forward.)

Now the Glens Falls Post Star’s Jon Alexander is reporting on the “unusual level of secrecy” that has surrounded talks over public health programs in Washington County, where local leaders want to privatize most public health services.

This from the Post Star.

The secrecy surrounding the negotiations over privatization of most of Washington County’s Public Health Department continued Thursday through hours of closed-door chatter that resulted in no resolutions.

The county Board of Supervisors Finance Committee spent about three hours in a closed-door meeting, debating a proposal from Fort Hudson Health Systems to buy the county’s home health care, hospice and long-term care programs, which make up the lion’s share of the Public Health Department.

Obviously, the counties and non-profits that provide these services are under severe budget pressure to make changes quickly, in large part due to lagging Medicaid reimbursements from Albany.

And I don’t doubt that everyone is working in good faith to make this transition work.

But I wonder whether this process — secretive in some cases, balkanized in others, and sometimes simply rushed — has allowed the various players in the public healthcare system to coordinate the way these crucial services will be provided, within counties and across the region.

As more of these services are privatized, are there plans in place for what happens when companies stop taking some low-income patients (as more and more health care providers are doing), or when firms go out of business, or choose to leave our area?

What happens if one nursing home or home health program shuts down, or downsizes?  How does that affect neighboring programs?

These aren’t abstract questions.  These are the questions that families will be facing in the months ahead, as health care systems that have been run by their local governments for decades begin to change rapidly.

It strikes me as odd that we debate and review some things for years — say, the proposed resort in Tupper Lake — while other things, such as the healthcare provided to thousands of our residents can change so rapidly with so little public discussion.

As always, your comments welcome.

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20 Comments on “Morning Read: The public debate over public health”

  1. mervel says:

    Excellent point about the difference between the decades long debate about building one resort and the zero debate about major changes in our access to public health.

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  2. Walker says:

    “…what happens when companies stop taking some low-income patients (as more and more health care providers are doing), or when firms go out of business, or choose to leave our area?

    What happens if one nursing home or home health program shuts down, or downsizes?”

    Yes, what happens, indeed? Well, who cares, really? As long as the taxpayer is relieved of the crushing burden. Just give ‘em a cardboard box and drop ‘em off at the nearest underpass. And hey, after the private companies buying up these institutions dump all the lower reimbursement residents, fire the higher paid workers and hire a bunch of barely qualified people at minimum wage, there’s some real money to be made here! Look on the bright side why don’t cha!

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  3. Pete Klein says:

    Sorry to say but the taxpayers are getting what they want.

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  4. bb says:

    This is just another symptom of the terminal disease suffered by the American health care non-system. Nothing is coordinated. Nothing is planned with the big picture in mind. Every healthcare entity, from the private doc to the local not-for-profit hospital to the huge insurance and pharmaceutical companies, is run by it’s own bottom line. Even if we have a social conscience and a real desire to do what’s right as an individual or as a corporation, we are left to compete with those who have no scruples.
    Health care should NOT be run as a business because patients are not willing “consumers” (with some exceptions) and we all pay for the failure of this system. This is why the United States pays more per capita (>$8,000) on “health care” (more than any other country in the world) and buys far less “health” than every industrialized country and many less developed countries as well (our actual ranking varies depending on what measures are used).
    Our country needs and all of our citizens deserve basic health care. Despite their faults, Medicare and Medicaid actually function better than any individual insurance company I’ve ever dealt with. A national health care plan is what we need and what most of us want. (I read somewhere that 78% of Americans are in favor of this). It’s the special interests and the politicians (beholden to special interests or afraid of their superpacs) who are against the concept.
    It looks like our local governments are throwing in the towel on health care because they seem to have no mandate from above or below to provide this care along with a committment to fund it.
    Personally, I’d rather see my taxes go to providing good prenatal care to prevent the alternative–a sick baby who requires a whole lot more expensive care after it’s born (one of innumerable examples of small investment up front saving a huge amount down the line).
    I bet most Americans would rather pay for a national health care plan rather than wars in Afghanistan and in whatever the next unfortunate nation our leaders choose to “help.” We’d probably have money left over to improve infrastructure and education too.

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  5. Walker’s sarcasm may be over the top but not by much. Many years ago I read that the way to get rich was to find something people want, or better yet need (health care, energy, whatever) and put yourself in a “gate keeper” position, they have to pay you to get it. When it comes to public services that is what privatizing does. It’s what “managed care” does. I remain unconvinced that privatization of public programs is the best, or even a good, solution. All their carefully worded mission statements aside, the primary goal of private enterprise is to turn a profit. The “mission” is subject to alteration in order to meet that primary goal.

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  6. Newt says:

    These discussions keep bringing back to me a memory of about 25 years ago.

    When my dad got too old to take care of himself, my sister took him into her home for a couple of months. That ended when she found that he was lighting his Pall Malls on the gas stove, forgetting to turn it off, then falling asleep in his chair with butt still burning. She had job, a husband, and three little kids at home.

    So she found Dad a couple of nice nursing homes, all of which he hated, but they eventually settled one he said he could accept. As she was moving him in, he had a massive heart attack. I like to believe he willed it. Unfortunately, the rescue squad in that town was apparently very efficient, and they brought him back. The family voted to turn off the life support a day later, per his oft-stated request of “no heroic measures”.

    Ah, the good old days of end-of-life care

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  7. Walker says:

    Meanwhile, you won’t want to miss this: Healthcare CEOs See Biggest Paycheck Bumps. ["...healthcare executive compensation jumped 7.8 percent in 2011. Healthcare companies’ net income rose 1.1 percent, while the industry saw a 9.8 percent one-year total shareholder return."]

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  8. Paul says:

    Public input is a good idea, but we have elected representatives to work for us. I don’t think you can sit around debating something for years while you are bleeding money. The reason the ACR decision took 7 years is partly because there was so much outside input.

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  9. Paul says:

    Yes, hopefully the NYS pension fund invested heavily in health care related stocks this past year. The NYS pension fund was up 6% for the year so that was a good result for the taxpayers and the workers.

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  10. Larry says:

    National Health will give everyone the same mediocre level of care and will bleed dry those who are willing – or who need – to pay for better. Without reining in the greedy doctors and lawyers who control the medical establishment any attempt at reform is doomed to failure

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  11. mervel says:

    It is a bizarre set of circumstances that kind of got the US sucked into the worst of the private and public systems all wrapped together.

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  12. Dave Mason says:

    Just for a fact check here: I believe there are only 8 for-profit hospitals in New York State. The rest are all not-for-profit. I looked it up. I had thought they we all not-for-profit. They are required to provide charity care.

    There is a long running debate about whether or not this is a good thing, but I don’t believe the law has been changed.

    Seems likely the poor elderly in the area will end up in the hospitals. But I’m no expert on these things.

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  13. Paul says:

    Dave, I think that all hospitals should be run as private not-for-profits. They create plenty of good jobs and economic activity and we can afford (as the public) to forgo any tax revenue from hospitals.

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  14. JDM says:

    68% hope for repeal of Obamacare
    24% hope it is upheld

    Times/CBS poll June 7, 2012.

    2,000 pages of hogwash that didn’t begin to address the real issues facing our nation’s health care.

    How’s it feel to on the fringe? 3-to-1 against.

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  15. knuckleheadedliberal says:

    My side of the fringe is just fine; how’s your side?

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  16. knuckleheadedliberal says:

    Ask John Adams about the tyranny of the majority.

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  17. Pete Klein says:

    If everything is about the rule of the majority, in theory the majority could decide to vote democracy out of existence. Maybe what the Tea Party people worry about is that when the whites become a minority, the new majority might decide it is pay back time and vote to make whites slaves of the new majority.
    Just saying.

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  18. Walker says:

    “…experts on health care policy say the practical effect of the court’s decision will probably be less earth-shattering than some people think. If the court takes what many observers believe will be the most likely route and strikes down the individual mandate — the requirement that virtually everyone purchase insurance — many more currently uninsured people are still likely to receive health coverage, they say…

    “I think much of the transformation of the health care delivery system is moving forward, regardless of the court action,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation in New York. “How do we get more efficient? How do we keep people out of hospitals? People are kind of gearing up for this. That’s going to continue. Obviously, it will continue at a faster pace if some of the payments for quality and efficiency in the law continue, but we are already beginning to see a slowdown in hospital costs nationally.”

    (Health Care After the Supreme Court Ruling)

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  19. mervel says:

    That is a good point, striking down individual mandates is not overturning the health care act.

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  20. “2,000 pages of hogwash that didn’t begin to address the real issues facing our nation’s health care.”

    It tweaked around the edges but nothing more. Did a few small improvements and a created few major bad things. The individual mandate (the ONLY instance I can think of where the government mandates ALL people purchase a private commodity as a condition of citizenship) was a great boon to the insurance racket… that’s why they didn’t fight it.

    This is why I support real health care reform: Medicare for All (single payer). I, and, other Medicare for All proponents are part of the 68% figure. Are you, JDM?!

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