- Arab American Family Support Center
- Committee of Interns and Residents/SEIU Healthcare
- Commission on the Public’s Health System
- CWA Local 1180
- Doctors Council SEIU
- Fort Greene SNAP
- Greater New York Labor-Religion Coalition
- Manhattan – Staten Island AHEC
- Metro New York Health Care for All Campaign
- New York Lawyers for the Public Interest
- New York Immigration Coalition
- New York State Nurses Association
The Uniting Principles
The Save Our Safety Net – Campaign (SOS-C) came together around a series of Principles that guided our work. The Principles bound us together in our determination to fight for: access to care for the uninsured, the elderly, and disabled; and to work on the racial and ethnic disparities in access to and outcomes in health care. Our review showed, that at least in New York City, the majority of hospitals had been closed in medically underserved communities. The SOS-C worked hard to ensure that the Hospital Closing Commission (Berger Commission) did no more harm and did not propose to close hospitals in medically underserved, low-income, immigrant, and communities of color.
The Berger Commission problems
The three levels of the Berger Commission were totally unrepresentative of the population of the state. There are even serious questions about the constitutionality of the law that set up the Berger Commission – these issues are currently being litigated in five courts around the state. Questions have been raised about the legislative bodies giving over their decision making power to an unelected body – the Berger Commission. Much of the work of the Commission was done behind closed doors, with very real questions about violations of the Open Meetings Law and the Freedom of Information Laws in the State. The criteria used in the decision-making was flawed and did not even consider health care needs as what should be a major factor in developing a “Hit List” of hospitals to be closed. Small community hospitals and state public hospitals were targeted for closing/restructuring/consolidations.
The New Vision for the SOS-C and for health care in the State
Quality health care should be culturally and linguistically competent and easily accessible geographically, which means it must be community-based.
Yet hospital closures and downsizings in the state have made access to community-based care increasingly difficult, particularly in medically underserved urban and rural areas, low-income, immigrant, and communities of color. Eight of the twelve hospitals that closed between 1995 and 2005 in New York City served predominantly people of color. There has been little or no attention paid to the development of community-based primary and preventive care services in underserved communities. Little, to no, funding has been directed to the development of this most needed care and services.
Quality care is preventative, in which all individuals have a medical home in which a primary care provider is able to coordinate that individual’s care.
But the state is failing to ensure that all New Yorkers have equal access to quality health care. Nearly 3.6 million people in New York State live in Health Professional Shortage Areas in 2001. Between 2001 and 2005, the number increased by an estimated 13.2%. (The federal government defines a shortage area as less than one primary care physician per 3,500 people, and less than one per 3,000 people in high-need areas). And more than half of New York City’s zip codes have a significant shortage of primary care physicians who are willing to see Medicaid patients, let alone to provide services to the uninsured.
In Central Brooklyn, a predominantly Caribbean and African American neighborhood, for example, the closure of St. Mary’s hospital, the maternity ward and WIC centers at Interfaith, along with the downsizing of the Kings County maternity ward have left the community with a stark shortage of OB-GYN services and maternity beds. There are only 104 certified OB beds for a population of more than a quarter of million women, yet the needs for such beds is great. The infant mortality rate in the area is almost twice the New York City rate.
All residents have the right to comprehensive, quality health care. We need universal health care insurance, so that ability to pay presents no obstacle to obtaining health care.
The U.S. and New York State pay enough to finance quality universal health care for all – we just don’t get what we pay for. We spend far more per person than any other wealthy industrialized nation in the world for our health care, yet there are still almost 50 million nationally, and three million locally, who are uninsured. The waste, fraud, abuse, and profiteering that plagues our health system diverts billions of precious health care dollars away from appropriate, effective care. The unnecessarily complex multi-payer system of health care finance also results in excessive administrative costs while harming quality, equity, and access. Without careful oversight, streamlined administration, and comprehensive community health planning these problems will continue.
Comprehensive, quality health care needs to include the complete span of life, from birth to end-of-life.
New York State needs to develop and fund a plan of comprehensive community-based services for the widely diverse continuum of needs presented by elderly and disabled individuals seeking assistance. Major components of the long term care system need to be well integrated, as an elderly or disabled individual may need services from one or more component, at any given time. For example, access between home, hospital, rehab nursing home, psych facility, hospital, nursing home, home are frequent stops in a given year to treat one individual in the system. Accordingly, records should be standardized, application to entitlement benefits made easier, quicker and case oversight made more holistic across the various system components. Nursing homes must be more home- like housing units, that adopt the ‘social’ model rather than the ‘medical’ model structure. Above all, a sufficient number of trained staff is essential to ensure that this vision is achieved.
For those able to remain in the community, consumer-directed choice in services is an important factor in fashioning long term care alternatives to institutional settings. Building and renovating affordable, accessible congregate living spaces that provide personal care assistance but that maximize independence are key to offering this alternative. Close family and friends need to be educated, supported and empowered to participate in health care decisions of their older loved ones.
The community must have a voice in planning health care delivery.
New York State needs a new network of health planning agencies capable of evaluating the match between the health needs of its residents and the availability of services. The new agencies could focus on establishing, maintaining, and expanding services through
* Collection of both objective and subjective data;
* Analysis of data by units relevant to communities, demographic groups, and health consumers with special needs.
* Development of recommendations on health care system changes with input from the general public.
* Widespread distribution of its findings and recommendations in a popular form
* Having input to funding and regulation of providers charged with implementation of recommendations.