Corporate model axes health care

It sounds like such good news. The New York State Commission on Health Care Facilities in the 21st Century, created by Gov. George Pataki and the state legislature, titled its final report, issued Nov. 28, “A Plan to Stabilize and Strengthen New York’s Health Care System.”

What does the commission suggest?

Does it recommend affordable health care insurance for all, regardless of employment? Does it urge hiring tens of thousands more health care workers, at living wages with benefits, in all areas of health care—especially to meet the huge increase in elderly patients seeking care?

Does the report call for reining in the pharmaceutical and medical equipment companies that are making exorbitant profits and driving up the costs of health care?

Does the commission argue for the need to open many more primary-care practices or clinics so that people no longer have to go to emergency rooms to find basic care? Does the report stress the urgency of opening up more beds in acute and long-term care to offer longer stays for patients whose families are caring for them after they were pushed out of hospitals? Does it demand round-the-clock home nursing care?

What about racist disparities, which exist in every type of health care delivery, and denial of health services to undocumented immigrant workers? Does this report address the significant new resources necessary to address these life-and-death obstacles to care?

The report had no proposals for any of these critical issues.

In fact, all the commission’s recommendations are premised on the proposition that there is too much “capacity” in the system. The report claims there are too many beds open in health care facilities. There is duplication of services at too many sites.

Therefore, the report argues, what’s needed is to cut back. Close beds, close hospitals and nursing homes, merge facilities, lay off thousands of health care workers and cut back.

The commission proposes to close nine New York state hospitals now. Plans include restructuring another 50, which would eventually eliminate 20 or more hospitals.

This would result in the loss of 4,200 hospital beds. Nursing homes are also to be “downsized,” eliminating 3,000 beds.

Hospitals and nursing homes marked for outright closings employ 7,000 people statewide. A similar number of jobs could be lost in future recommended mergers and consolidations, mostly in upstate New York, an area already devastated by plant closings and high unemployment.

This is only the first stage, the report states. Large cuts in Medicaid reimbursements are next.

After the commission’s recommendations have been presented to and approved by Gov. Pataki, the legislature must accept or reject the entire proposal, without any changes in any aspect, before the end of this year.

The proposed restructuring all sounds very familiar to workers, impoverished and oppressed people who have watched businesses downsize and move out of their communities, taking with them the wealth the workers created. This has left many workers jobless and their communities stripped of the riches accumulated though their labor.

Pataki, with the approval of the New York state legislature, appointed Stephen Berger, an investment banker, to chair the commission. Berger previously served as executive vice president of GE Capital from 1990 to 1993.

GE Healthcare markets a wide range of high-tech products used in health care, services equipment, trains professionals in management techniques to improve productivity and provides health care financing. GE Healthcare lends facilities large amounts of money to buy their products or to use for capital improvements. The firm creates “leadership teams” within the institutions and is then involved in many aspects of the organization. (www.ge.com)

During the height of New York City’s financial crisis in 1976 and 1977, Berger was the first director of the Financial Control Board. He pressured the city to carry out massive cutbacks in services and layoffs of workers.

For the New York State Commission on Health Care Facilities in the 21st Century, Berger set up a group of commissioners on the state level and regional advisory committees. Almost all the commissioners are bankers, CEOs, lawyers or others who would see the profitability of health care institutions as extremely important to their own businesses. This includes energy providers.

The commission promised the public that there would be complete openness in its 18-month-long process, encouraging broad consultation. It promised open meetings and public hearings.

However, during the New York State Assembly Public Hearing in Buffalo on Dec. 11, there were many complaints that the state commissioners’ meetings over the previous months were not open to the public as had been promised. There were also no practicing physicians or nurses on the commission.

One of the commission’s first acts is securing a large sum of money to carry out the process of restructuring, including closures and construction costs. This money would not be designated for direct health care services.

The commission reports that $2.5 billion in state and federal funds are available. A significant portion will most certainly be used to create a bloated bureaucracy made up of high-priced lawyers, financiers, vendors and administrators who are far too eager to be part of this stage of restructuring.

According to a Nov. 28 news release, all the commission’s recommendations must be accepted by the legislature and implemented in order to receive those funds. The collusion among the federal government, the state and the commission is already being denounced by opponents to the recommendations.

These billions of dollars could provide tens of thousands of uninsured and underinsured people access to health care.

Capitalist restructuring

The commission’s next step is to carry out the restructuring. The total projected benefits—to Wall Street and corporate creditors—will be $1.5 billion annually or $15 billion over 10 years.

The impact on health care workers, the community and patients will be thousands of layoffs, hospital and nursing home closings, and major disruption to families and communities.

This restructuring of the New York state health care system, considered to be the most extreme in decades, occurs at a time when the capitalist economy is slowing down rapidly.

Plants continue to close, jobs are being lost and workers are either losing their health insurance, receiving less coverage or paying much more. For many it is just too expensive. There are 47 million uninsured people, and possibly as many underinsured. It is safe to say that most undocumented workers do not have health insurance.

There is a great increase in the rate at which workers and the oppressed are losing access to health care. Employers are maximizing profits by reducing benefits, including limiting insurance coverage.

This is a national crisis, but the effects are very evident in New York state. The next governor, Elliot Spitzer, will enter office Jan. 1 in a state with a totally inadequate health care system and a $48.5 billion debt.

New sources of revenue must be secured to meet the most basic yet critical human need for health care.

Money for health care, not warfare

The money being spent on war should be used for social services instead. New estimates put the overall cost of the Pentagon war in Iraq and Afghanistan at somewhere between $1 trillion and $2 trillion. The higher amount would provide four times the amount needed to provide health insurance to uninsured people in the United States for the next decade.

The delivery of health care is a big business based on profit. The bottom line is minimizing costs and maximizing profits. Many not-for-profit or public hospitals are still at the mercy of high-profit-seeking pharmaceuticals, medical equipment suppliers and banks. The powerful lobby of pharmaceuticals continues to block efforts to use Medicare’s purchasing power to negotiate lower prescription prices for retirees.

Health care CEOs may talk about delivering the best possible care. However, this is not what is generating the call for restructuring. Their bottom line is profit.

The Commission on Health Care Facilities report is business restructuring in a capitalist economy. Restructuring has never made life better for anyone but the rich corporations and banks. It pits workers and other community health care agencies as competitors.

In testimony at the recent assembly hearing in Buffalo, representatives from Communication Workers Local 1168 Nurses United called for unity in the struggle to assure that all have high quality health care.

The organization of a fight back began immediately upon the release of the Berger Commission Report.

Civil Service Employees Union President Danny Donohue, who represents 265,000 active and retired public and private employees across New York state, testified on Dec. 1 at a State Senate Health Committee public hearing.

Donohue expressed his union’s view that the commission’s recommendations of significant privatization, mergers and cuts to many public hospitals and nursing homes where CSEA represents employees is “shortsighted, misinformed and potentially harmful.”

The executive board of New York state Public Employees Federation reallocated $50,000 from the Go Public campaign to start the wheels in motion for a media blitz, rallies, lobbying efforts and whatever it takes to persuade the legislature to oppose the plan.

All these unions will rally in Albany on Dec. 13.

The Save our Safety Net Campaign has formed as a broad coalition of community organizations, labor unions, religious leaders and health care advocates. SOS-C is organized to address the potential health disaster that could result from implementing the Berger Commission Report. The coalition calls for justice in the process of designing a health care system for the 21st century that provides access to affordable, quality health care for all New Yorkers.

Together these growing alliances are a powerful force toward change.

Hiestand worked as a clinical educator for 27 years in a large health care system in Buffalo, N.Y. She helped organize the first union for registered nurses and represented nurses as a chief steward.