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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

Election Special--Health Care

(Oct-Nov '00) Though the Senate race between Hillary Clinton and Rick Lazio has been marked largely by personality conflicts and battles over campaign financing, there are some significant differences between the candidates on health-care issues. For New Yorkers, this race may be the most important local contest on the issue, though of course, the outcome of the Presidential elections and of other Congressional races affecting the balance of power between the parties will be crucial as well.

Perhaps the most prominent difference between Clinton and Lazio is their varying perspectives on the "patient's bill of rights." While both candidates say they support a patient's bill of rights to give better health care access to people insured by HMO's, Clinton's proposal is closer to what most patients and health care advocates see as a comprehensive package.

Clinton supports the right most patients want and most insurers fear: the ability to sue HMO's for malpractice if payment for needed care is denied. Lazio voted for the Republican version of "patient's bill of rights" legislation which includes the ability to appeal disputed payment decisions to an outside party but not the right to sue if HMO decisions result in injury or death. Lazio also supports tax deductions to help people pay for health insurance.

Another major difference is the candidates' views on abortion. Not surprisingly, Clinton is completely pro-choice. Lazio has some reservations about abortion rights: he supports legislation against a late-term abortion procedure which opponents call "partial birth" abortion and opposes federal funding for abortions as part of health benefits for poor women. He does not support an outright ban on abortion or the reversal of Roe v. Wade.

Clinton and Lazio also differ on their positions on funding for prescription drugs for Medicare patients -- an issue which has been highlighted recently in the Presidential campaign. Clinton supports Gore's plan for providing prescription drug coverage to the elderly and she also supports legalizing the importation of cheaper foreign drugs. Lazio favors a federal subsidy to insurance companies to encourage them to provide prescription drug coverage for the elderly and allow them a choice of two different plans.

On coverage for the uninsured, Clinton has said that she wants to expand Medicaid coverage to include all uninsured children and the working poor. Lazio questions how such a large program would be paid for.

Lazio tried to make an issue of the coverage of mammograms in Clinton's failed 1994 national health insurance plan -- however, both candidates actually take the same position and support coverage for women over 40. Clinton's proposal initially didn't include this because when it was written, the data was unclear as to the benefit of mammograms for women between 40 and 50. Both candidates also supported legislation which "carved out" money from Medicare to fund teaching hospitals.

Maia Sounds Off:

As a self-employed person who gets health insurance through the National Writer's Union, I am acutely aware of its cost and of the fact that I was up until recently, a member of New York's uninsured. I have covered and personally experienced some of the absurd barriers HMO's put in the way of healthcare. To list just two: pregnancy and birth are covered, but not contraception; Wellbutrin is covered for depression -- but not in its form as Xyban [the exact same drug] for quitting smoking. Both illustrate the short-sightedness of the benefit managers and reveal that HMO's are ultimately a poor way of paying for health care.

This should have been apparent to Hillary Clinton and her commission when she tried to reform health care in 1994. Once HMO's cut actual waste and fraud, they ultimately increase costs by creating a self-justifying layer of bureaucracy which doesn't practice medicine but tries to cut even where cuts make little sense.

Hillary's current positions on health care are closer to mine because she recognizes that HMO's need to be held legally accountable for the medical judgments they make and because she understands that a woman doesn't have the right to choose if she has no money to cover abortion. However, I don't think our healthcare problems will be solved until we recognize that we need at least a bare-bones national health care system

This eliminates HMO bureaucrats who are accountable to no one but their shareholders -- and if done right, physician salaries, hospital and lab costs could simply be paid directly by the feds without creating too many new government overseers. If there have to be regulators, most people would rather they be concerned with patient health and safety, not corporate profit, anyway.

Further, having such a system for everyone will in no way interfere with the middle and upper classes' desire to get additional insurance or treatment which isn't covered. It wouldn't be "socialized medicine" in the sense that you get what the government gives, and that's it. You can choose more -- but no one would be denied basic care. There may be waiting lists on the NHS in the UK and Canada -- but everyone has coverage and the middle and upper classes can supplement it with private insurance and private doctors. Why shouldn't we have such a sensible system in America?

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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