Overview

First, I want to thank the Cardozo Law Democrats for inviting me, and I also want to thank all of you – students, faculty, and visitors – for being here today. I am honored to be at this great law school.

Today, I will give the seventh in a series of addresses outlining the real solutions a Weiner administration would institute to improve the lives of middle class New Yorkers, and those struggling to join the middle class.  I’ve outlined my plan to reduce the tax burden on middle class New Yorkers and bring economic development to all five boroughs, proposed a series of good government reforms and called for an end to backroom deals and pay to play at City Hall, described my vision for our schools and unveiled a plan to end childhood hunger in the City.

I come from New York’s middle class: my mom was a school teacher, and my dad hung his shingle outside the door.  Today I want to talk about one of the very biggest issues we face: the crisis in health care.  I want to discuss how we can improve health care both for those who depend on Medicaid, and those outside the Medicaid system.

Let me say at the outset what I think is obvious.  New York City boasts some of the best health care facilities and professionals in the world.  375,000 New Yorkers – a full 10% of our City’s workforce – care for the sick and the frail in this city and they deserve everyone’s appreciation.

But New York City is facing a health care crisis.

First, those struggling to join the ranks of the middle class are not getting the care they deserve.  The life expectancy of those living in New York’s poorest neighborhoods is eight years shorter than those who reside in the City’s wealthier parts.

Second, too many New Yorkers live in fear of getting sick because they don’t have health insurance.  A quarter of the City’s population under 65 – 1.8 million New Yorkers – are uninsured.

Third, we are delivering care through a health care system that is not only antiquated, it is unnecessarily expensive.  Since the Mayor took office, the City’s share of Medicaid – the government’s program to provide health care to the poor – has grown 47%.

We are near the breaking point.  And we need aggressive leadership from City Hall to get a handle on the situation.

Politics and Health Care

Let me say briefly that reforming health care is a hard and complicated topic. I will describe some of the statistics that define our situation in a moment. But ultimately this is a human crisis. Human beings without insurance, families that worry desperately about losing a job and a lifeline to care, and New Yorkers doing their very best to provide care for loved ones.

About 8 months ago the New York Times did a story about a remarkable Queens family in which two young men – one a police officer and the other a sanitation worker – helped their mom take care of their sick father.  I remember a line from that long article – something the mother said: “Both of us have been robbed of everything we worked for.”

That is the human side of this crisis.

The sad fact is that too few of our political leaders are taking on the crisis in health care.  The political process is MIA.

On one side, you have Mayor Bloomberg who just does not recognize it is a problem.  A couple of months ago, he committed what in politics is called a blunder, but in real life is called saying what you really think.

Bloomberg said, and I quote, "Medical care in this city is arguably one of the few services you can point to anyplace in the world where the poor get better services than the wealthy."

And that is the standard Republican worldview. The poor and middle class have it pretty good.  So I wouldn’t expect more from that side.

And on my party’s side of the mayoral debate, we either aren’t hearing any ideas or we are only hearing ideas about how to spend more money.

The truth is we need action – but it can’t be more of the same.  Patients hear lots of good sound bites from some politicians on my side, but nothing new.

If you are worried about getting sick in New York, you hear good rhetoric and no new ideas on one side, and bad rhetoric and no ideas on the other.

Either way you are still sick and broke.

We need good, new innovative ideas, and we are going to have to break a few eggs to get quality affordable health care to more people without breaking the budget.

Let me be straight from the outset: fixing the healthcare system is this city will be no easy task.  It will require us to make some difficult choices.  Those who are invested in the status quo will fight hard against attempts to innovate, modernize, and save.  But the problems the City faces are too big, and the consequences too important for us to sit by and let institutional inertia prevent us from ensuring that New Yorkers have the health care system they deserve.

Washington and Albany Must Act – But We Can’t Wait

We need to acknowledge that change is needed in ways that we provide health care nationally.  Let’s take a look at just how big a crisis we are facing:

The costs that businesses face when trying to insure their employees are exploding.  The Kaiser Family Foundation found that the health care premiums paid by small businesses nationally rose by 15.5% in 2003 alone.  Between 2000 and 2003, the percentage of non-elderly Americans with workplace health coverage decreased from 67.1% to 63%.  And we’re not just talking about the unemployed.  60% of the nation’s uninsured come from families where the head of the household cannot afford (or is not offered) health care insurance from his or her employer.

In turn, businesses are passing costs along to their employees – to the point that 33% of New Yorkers (statewide) believe it is likely that they will have to drop their employer-provided health coverage due to increases in out-of-pocket costs.

The United States spends more on health care than any industrialized nation in the world.  Nevertheless, roughly one of every four non-elderly adults is uninsured, and that number is expected to grow.

How have the Bush and Pataki administrations responded?  The president’s most recent budget called for a $60 billion cut to Medicaid over the next ten years.  And the governor initially recommended to the state legislature that we cut $807 million from the New York’s health care budget.  

So the next mayor will not have the luxury of simply waiting for things to change.  We need to reform Medicaid.  We need to figure out ways to cover as many New Yorkers as possible.  And we need solutions that address the concerns of middle class workers and small businesses.

Reforming Medicaid to Save Money and Improve Care

Medicaid, the government’s program to provide health care to the poor, needs to be improved.  First, we need to ensure that every New Yorker eligible for care through Medicaid is enrolled.  Second, we need to make sure that the care we are delivering to Medicaid enrollees is being provided in the most efficient, caring, and cost-effective way.

How would I do it?

First, I would modernize the current system of enrolling and renewing Medicaid-eligible New Yorkers.  According to the United Hospital Fund, a full 800,000 New Yorkers eligible for Medicaid are not currently enrolled.  Three-quarters of Medicaid funding comes from Washington and Albany, so we need to fight to enroll every eligible New Yorker.   

As Mayor, I would set a goal of enrolling two-thirds of Medicaid-eligible uninsured New Yorkers simply by bringing the process of enrolling and renewing enrollees into the 21st Century – more than 500,000 New Yorkers.  How?  By making sure that New York catches up with states like California, Georgia and Pennsylvania by using electronic records to enroll and renew Medicaid recipients.  TheHow

The current paper-based, redundant application requires information to be hand entered for the entire range of health care benefits and sent for a range of bureaucratic approvals. An electronic system would automatically save basic data, allow faster processing, and ensure higher patient enrollment by streamlining approvals and eliminating redundancies.

In 2001, New York State spent $1.1 billion for the direct administrative costs of all Medicaid programs.  Each year, New York City spends roughly $500 million processing new applications and renewals.  The United Hospital Fund estimates that very simple IT innovation would save a half-million hours of staff time each year (250 full time employees at health plans, providers and community-based organizations), while a more comprehensive overhaul could save far more.  New York City has had WebMD on contract since 1999 to modernize the City’s enrollment system – but to no tangible result.

Second, I would make sure that Medicaid recipients get more of their care from primary care providers, leaving specialists and hospitals to focus on the most acute health problems.   

We should look to North Carolina as an example.  That state’s Primary Care Case Management (PCCM) program works to link Medicaid recipients with primary care providers in their local community, driving down costs by keeping them out of emergency rooms.  Primary care physicians work with local hospitals, health departments, and social service departments to identify high-cost patients and services and ways to manage those costs.  The physicians who work with the program have also undertaken a comprehensive review of prescriptions given to Medicaid patients and have prioritized certain drugs that offer the greatest potential cost savings for the program, lowering drug expenditures by 22%.  

Third, I would dramatically expand programs that provide comprehensive home health care services for elderly, keeping many of them living happier, healthier lives outside of expensive institutional settings like nursing homes.

As an example we should look to programs like PACE, the Program for All-Inclusive Care of the Elderly, which uses Medicaid and Medicare dollars to provide comprehensive care – doctors, medicine, food, therapy, transportation and even help with everyday needs like managing a bank account – to frail elderly New Yorkers who would otherwise be placed in a nursing home.  By investing a few dollars up front, and keeping these New Yorkers out of expensive nursing homes, we will both keep them more independent and save government dollars.

How do we grow programs like PACE?  First, we cut the institutional barriers that prevent them from flourishing.  The process of getting approvals from federal, state and local government bureaucracies often scare health care providers from starting them up.  Second, we use incentives like real estate tax abatements to landlords that might house a PACE to in order to offset the start up costs.   

Providing Health Insurance to the Uninsured

Next, we need to focus on covering the hundreds of thousand of middle class New Yorkers who are uninsured but who are not eligible for traditional Medicaid.

Take, for example, Child Health Plus, New York State’s program for providing health care to children.  This is a program that expands Medicaid to ensure that all children have access to health care.   

When a child qualifies for a lunch subsidy, his or her parents should be asked if they have health insurance.  The income requirements for school-lunch and subsidized Child Health Plus are similar, so when a child qualifies for school lunch, his or her parents should be approached about getting their child insured.   

As mayor, I would institute a program like the one developed in Stamford, Connecticut called "Every Child Matters." In the fall of 2000, the city’s Health and Social Services Department began requiring parents and guardians to indicate their children’s health insurance status as part of the annual school enrollment process. In consultation with school nurses assigned to both public and private schools, each family with an uninsured child is contacted first by mail and then by phone to explain the State’s health coverage for children.

Every Child Matters is particularly effective because it piggybacks on the health information that the nation’s schools already collect from parents: vaccination records, emergency contact information, special health needs, among other things. It also both capitalizes and builds on schools’ relationships with parents as a trusted source of information. And most importantly, it begins with the premise that all children should have health insurance, and if they do not, the resources are available to make sure they do.

Helping Small Business and Middle Class Workers Afford Health Care

Finally, we need to get more funding from the under-utilized programs that help small businesses purchase health insurance and prescription drugs for their employees.  

Of the 1.8 million New Yorkers who are uninsured, a staggering 969,000 work full-time.  We can do much more to expand the pool of businesses and individuals with access to programs that insure individuals for a monthly fee of less than $150 per individual and less than $400 per family.  If we set a goal of insuring a little over a third of these workers, combined with our efforts to expand Medicaid enrollment, we could provide heath care coverage to as many as half of the 1.8 million New Yorkers living without any health care insurance.

First, we should expand and improve programs that allow small businesses and individuals to pool purchase health care for their employees – bringing the costs down for currently uninsured New Yorkers.  While the State and City have invested in establishing a few projects, I would dramatically expand the eligibility, so that more uninsured employees of more businesses could utilize the power of pooled purchasing.

There are inspiring examples of the use of incentives, new marketing ideas and public private partnerships we should be able to draw upon to increase coverage for working people.  

Let me give you a brief example of some of the things being done by Brooklyn Health Works.  It is a true public-private partnership designed to substantially reduce the cost of healthcare insurance premiums so that small business owners can afford insurance for their employees.  They have a marketing and advertising strategy that stresses concern for the economic health of the community as well as the physical health of members who subscribe to the plan.

Brooklyn Health Works is a consortium that has a partnership with the Brooklyn Chamber of Commerce and other smaller, ethnic chambers, trade groups, creating several important distribution and marketing alliances. The Chamber membership alone represents nearly 20% of the targeted business prospects.

Second, we should make it easier for the uninsured – and those who have health insurance that does not cover the cost of medicine – to buy drugs at a discounted rate by pooling their purchasing power.  While New York City has begun a program to purchase drugs, the current plan does not provide the savings that would be passed onto seniors if the City pooled their efforts to buy drugs with other states and municipalities.

New York State’s drug card program for seniors, called EPIC (Elderly Pharmaceutical Insurance Coverage), saves the average senior about $2,000 in drug costs per year.  But a substantial number of New York City’s elderly population is eligible for EPIC, but unenrolled, an oversight that costs those unenrolled seniors $786 million a year.  The first thing we should do is more outreach to the communities that would benefit from this savings.  The second thing we should do is demand that the State expand the program to include all New Yorkers who do not have prescription drug coverage.  Expanding the pool of eligible participants beyond the elderly community should allow even great health savings that exist today.

Conclusion

These are some ideas for taking on the health care challenge. They reform the system, provide more appropriate care, and save money.

With the outreach plan I propose today, we should be able, in the next four years.   That would amount to providing health care coverage to as much as half of New York City’s uninsured population.

When combined with the efficiency measures I propose – computerizing our admission systems, providing more appropriate care to seniors, focusing on preventive care and easing the burden on emergency rooms, pooling our bargaining power in prescription drug purchases – we can provide more and better health care.  And our cost savings will cover the cost of providing more New Yorkers health insurance. That is a bargain worthy of Syms.

Right now, the condition of New York City’s health system is enough to make you sick.

If we reform how we handle Medicaid, help small business offer affordable health insurance, pool purchases of prescription drugs, and change how we provide care for the elderly – we can make a difference.

I said my campaign would be a fight for the middle class and people struggling to make it. Health care is the first battlefield. Any leader who really cares about improving this city will take on the challenge of health care.

“More of the same” is not a solution. Neither is saying the poor have it good – as our mayor does.

Every child, working person and senior begs us for a better approach.

I intend to offer it to them.

Thank you.