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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

The Uninsured

(April '01) As the economy boomed, little attention was paid to the millions of Americans who lack access to health care. Ominously, for most of the good times, the number of uninsured continued to grow; it went up 40 percent in ten years, with just a slight drop starting in 1999.

But now President Bush wants to cut funding to programs that provide healthcare access to the uninsured by 86 percent -- from $140 million to $20 million -- and with the economy going south, experts are predicting a disastrous rise in the number of Americans without health coverage.

In New York State, some three million people are uninsured, most of these in New York City. In 1999, Governor Pataki raised the cigarette tax by 55 cents a pack to provide coverage to some of these low and moderate income families. (Only their children had previously been eligible). But though $400 million has been raised, the program has yet to materialize, in part because negotiations with the federal government about how much it would contribute have yet to be completed.

"The governor's office originally blamed the Clinton administration for the lack of progress, now they blame the 'transition' between administrations," says Richard Kirsch, Executive Director of Citizen Action of New York. "The state has the money. They should start spending it now and negotiate with the federal government later."

Although the Pataki administration has recently begun to seek proposals from Health Maintenance Organizations to run the new program, which is called Family Health Plus, no uninsured people have yet been covered.

Meanwhile, the New York Times front-paged a story about a growing price disparity throughout the medical system that even further exacerbates the problems of those without health insurance. The uninsured are actually charged higher prices for most medical care than that paid by people with insurance. The problem developed because insurers negotiate with doctors and hospitals to offer group discounts. Few, on the other hand, speak for the uninsured.

Irene Wielawski first called attention to the situation with an article in a recent issue of a policy publication, Health Affairs A former L.A. Times health writer, Wielawski had been studying programs to help the uninsured, funded by the Robert Wood Johnson foundation. She now lives in New York.

When her teenage son developed a hernia after an over-enthusiastic performance on his trombone,Wielawski's insurance covered the surgery. Since she was reporting about an uninsured carpenter who needed similar surgery, she sought to compare the charges.

She found that the total paid by her insurer was $3,509.50. The carpenter, however, would have been charged between $6,000 and $10,000. The hospital said it required a down payment of $1500, far exceeding the $100 the carpenter had managed to save. The injury meant he could not work, which meant he could not make money to pay for the surgery. He only escaped this catch-22 when a charity agreed to pay.

Says Wielawski, "[My project for Robert Wood Johnson] put me in touch with hundreds of uninsured people. I started to discuss the bills they were getting." Insurance companies usually will not release information to journalists about what prices they pay for services because they are the subject of much negotiation. But patients and their families have access to their own bills. "I encountered this only because of serendipity," she says. "I realized, of course, the insurers get a group discount. It's a bitter irony."

Says Kirsh, "It's outrageous. It's another example of how cruel and bizarre our health care system is. Hospitals and doctors shouldn't be charging the uninsured more than the insured-- and they shouldn't use their contracts with HMO's as an excuse."

He adds, "It's not as though they make money on it. They would do better settling with them than trying to collect the debt. If the [uninsured] did pay, it would be the poor subsidizing the rich, but what it is really is harassing the poor with the threat of bankruptcy and loss of credit."

With tougher bankruptcy laws being heavily promoted by the credit card industry, an outrageously high hospital bill could push some poor families into a financial tangle from which they could never escape.

Some companies now sell cards that offer health care discounts to the uninsured, by negotiating group discounts with providers, as insurers do. But the cards are not insurance, so expensive procedures could still be well beyond the means of those who enter the discount plan, which is offered on a month by month basis.

While Kirsh believes the only real solution is a national health care system, he says there are some signs of progress. "The programs for children continue to grow and we're seeing a steady expansion of [state] programs for low and moderate income families like Family Health Plus. Adding prescription coverage to Medicare is a positive sign. These are the positives amidst the sea of darkness."

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.
  • - 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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Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

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