Health
Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 7 million residents--over 1 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone. Run by New York City's public Health and Hospitals Corporation, the hospital system now has a surplus of $21 million, following years of deficits and cutbacks.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

How Albany Matters In Health

The New York City Department of Public Health has a budget of over $1 billion - larger than the health budget for many countries, let alone those of other states.

As Commissioner Thomas Frieden put it in recent testimony before the City Council on the mayor's budget, "Few other institutions touch the lives of so many New Yorkers in so many different ways." He went on to list many of the functions, such as issuing birth and death certificates, controlling pests, monitoring illness, and making sure the city is prepared in case of emergencies such as epidemics or bioterrorism. But he did not mention the many ways in which the legislature in Albany and the state health department influence and control the function of his agency and perhaps even more profoundly affect the health of New York City residents.

"Health care financing obviously has a tremendous amount to do with health care in New York City," says Richard Kirsch, executive director of Citizen Action of New York. And spending decisions made in Albany profoundly affect what the city can and cannot do.

THE CIGARETTE TAX

Even the recent decision to raise the cigarette tax in the city alone had to be OK'd by Albany. The $1.50 per pack tax on cigarette sales applies only to the city - but the city is not permitted to set such taxes on its own residents itself.

However, while the tax is expected, according to the Mayor, to save the lives of at least 33,000 city residents by reducing smoking rates (research estimates that for, example, a 22 percent tax increase would decrease smoking by youth by about 15 percent and smoking by adults by roughly seven percent), its revenue will be used not for smoking cessation or prevention or even for general health expenses, but to help close the city's overall budget gap.

This non-targeted use of cigarette tax revenues is something of a pattern with Albany. While the most recent previous increase was pitched as a way to cover healthcare for the uninsured, advocates say that that is not how it is currently being used.

"We think it is being used to finance raises for healthcare workers," says Kirsch, referring to a package of raises for health workers passed early this year. Many critics have complained that this legislation, which increased spending during a fiscal crisis and relied on uncertain revenues, was fast-tracked through the legislature to win support from powerful healthcare unions for Governor Pataki in the November elections. "We think raises for health care workers are important," says Kirsch, "But we think that money raised to insure the uninsured should be used [for that purpose.]" "I'm not opposed to cigarette taxes," says Karen Schimke, president of the Schuyler Center for Analysis and Advocacy, which advocates for low income New Yorkers. "But I am ambivalent about using them to support the public health infrastructure. Use them to fund antismoking campaigns."

PROGRAMS FOR THE POOR

Both Kirsch and Schimke also point to the control Albany has over health care programs for the poor, including Medicaid, Family Health Plus and Child Health Plus. The city is unusual in having to pay for a portion of these programs -- in most places, the funding is split simply between federal and state government -- and yet it has little control over eligibility for them.

"We saw with Disaster Relief Medicaid that if the state gets rid of barriers, there is a huge increase in enrollment," says Kirsch, referring to the post-9/11 health care aid program which allowed city residents to enroll for health coverage under Medicaid and get immediate access to care. Eight times as many people applied as had done previously in a similar period of time. Eligibility ended in January, however - so people applying now have to go through the traditional multiple visits and mountainous paperwork again.

Schimke believes that the way the state screens people for the program is inherently inefficient. Private businesses do not try to audit every single customer. In situations where fraud or abuse is possible, they spot-check a representative sample and detect problems that way. But state health programs for the poor are so determined to be sure that no one cheats and gets healthcare for which they are ineligible that each applicant is thoroughly vetted -- which means it can be months from the time of application to the time when care is available. Such red tape can be reduced. "9/11 proved that it can be done," says Schimke. Both Kirsch and Schimke agree that the single most important thing the state could do to improve health care access in the city is to make permanent the streamlined application process demonstrated in Disaster Relief Medicaid.

More people on Medicaid actually means savings for the city. This is because all healthcare for the uninsured is paid for by city hospitals, but the city must cover only 25 percent of Medicaid costs. This cost conflict, however, may underlie why the state prefers greater barriers to access than the city does and why efforts to make the reforms of Disaster Relief Medicaid permanent so far have not passed.

ADULT HOMES

Other areas where the state has a major influence over city residents' health include regulations which cover programs like adult homes for the mentally ill, which have received attention lately due to horrendous failures to provide safe and appropriate care. "They are worse than the mental hospitals were," says Schimke, who believes that additional city and state oversight would help add more protection for vulnerable residents.

State legislation has also literally banned the creation of new outpatient mental health clinics in the city, a cost-saving measure which has done nothing to help those with mental illness who need services. "It's just because they don't want to spend the money," says Schimke.

While Albany's influence is often indirect -- through regulations affecting eligibility for programs and oversight of health care providers -- it also directly influences how much funding is available to the city to spend on health and how this money can be spent. The balance of state and local control is determined largely by taxing powers, which are much greater at the state level and unlikely to change. New Yorkers concerned about health issues certainly must keep an eye on Albany!


Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.


Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • AccentHealth.com - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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