A Health Care Reform Suggestion for Governor Paterson

Governor Paterson is complaining that the new federal health care reform bill would cheat New York State. Of course it would. The deal is, was and apparently always will be that New York State's powerful finance and health care industries drain the rest of the country, and in exchange the rest of the country cheats the rest of New York State's residents in every other way. (Housing used to be in on the deal in New York, but now it isn't). That is the deal our national politicians cut in Washington. And it is also the deal, excluding Wall Street but including older city residents and retired and near retired public employees, that New York City's state politicians cut in Albany. Since most city resident don't matter, and neither does its future, to the interests in charge. If Governor Paterson has a problem with this, I have a suggestion...

An all out residency crackdown for services under Medicaid. Other states have been attracting working New Yorkers and businesses for decades with promises of lower taxes and (compared with the city) better schools, but sending back those who are ill or troubled. This benefits Local 1199 and the Greater New York Hospital Association, which not only gets Medicaid funding for providing expensive services to New York State residents, but also gets extensive funding for providing expensive services for half the eastern seaboard, and some countries abroad.

People show up, have a cup of coffee, claim to be residents, and go in for their operation. New York State taxpayers, thanks to the federal funding formula, pay for 25 percent of the cost, and New York City taxpayers pay for 25 percent. But because New York City taxpayers also pay state taxes, they in fact pay for 35 percent of the cost.

Except for retirees, particularly retired public employees, who don't have to pay taxes no matter how wealthy they are. And the non-profit sector, including much of the health care sector, which is also tax-exempt. And large companies with tax deals. Etc. Etc. Etc.

In addition to working age people who need operations, you have seniors who leave New York when they have money and health, and return when the money is gone and they require care, to the place with the most senior citizen privledged (and child and new business hostile) set of priorities in the U.S.

And while my personal knowledge of how this all works is a little dated, guess who fills out the applications and figures out if someone qualifies as a state resident? Why the hospitals themselves! And the more they decide people are state residents, the more money they make. I know this from a long conversation with someone whose job this was at the time. He said they ought to get rid of Medicaid and come up with a national system, so if other states wanted to send people to New York for care everyone would pay, not just people in New York State.

Well that isn't happening. Employees will still be tied to their place of work by health insurance as they age, unable to leave but liable to be fired. And the Medicaid formula will still be used to drive people away from the Northeast by raising their taxes.

That formula also ensures that whoever gets stuck with the the needy old declines inexorably. And, of course, we have the biggest middle-class "Medicaid planning" industry in the country.

The solution? If they want to go to Florida when they have money, they should stay there when the money is gone and they have needs. If health care reform passes, New Yorkers will be paying for people to get care where they are, and people will be able to get that care. If those from elsewhere are allowed to continue to get it here as well, it is only because the Greater New York Hospital Association and Local 1199 are paying for them to be able to do so, in campaign contributions. Let's get one benefit out of universal health care if it passes, and stop paying for Medicaid for non-New Yorkers.