Remarks to the Greater New York Hospital Association

Greater New York Hospital Association
Roosevelt Hotel
New York, NY
Thursday, April 24, 2008

Thank you so much for having me here today. And thank you for all of the work that you do, particularly the cooperation that our new administration received from all of you in our—believe me—embryonic stage of development right in the middle of a budget process.

Some reporter said to me, “Aren’t you ashamed that the budget was nine days late,” and I told him, “No, because I got there 56 days late.”

We are very happy to bring our message to all of you, and to thank you not only for your cooperation with us, but what you have done for all of the people in State of New York; all of us who need health care; all of us who are trying to live healthy and safe lives; and your contribution to that is one that continues and exists and is not often recognized and so I just wanted to start by thanking you all.

I wanted to thank Ken Raske for that introduction. He told Congressman Rangel for 20 years that he wanted to introduce him as Ways and Means chair. He never told me he wanted to introduce me as Governor, or I would have gotten to work on this sooner.

And I am very pleased to have with us today a man who for 30 years got up every morning and went and worked at a hospital. And we wanted to try to take advantage of that knowledge; all of his administrative abilities; all of his great wisdom on these types of issues, and that’s why we asked Commissioner Richard Daines to come and join us at the beginning of this administration. And so I wanted to recognize him.

The next person I’d like to recognize is an individual whom my chief of staff and I have a little nickname for but we’ve never told him about his nickname. We call him “the adult in the room.” Because whenever there is a problem—and everybody else is at their wit’s end or frizzing out or losing patience—he seems to have a workable, sensible and achievable solution to everything: our Secretary for Health Care, Dennis Whalen.
                                                                                                
And finally I’d like to introduce someone who called me in the midst of my period of transition—personal transition—when within an hour my life changed and I left the Capitol and went home and I thought everything will work out and then opened the window and there were 20 cameras. Then I turned on the TV and they said the Lieutenant Governor is in the house—maybe he will come out and talk to us. I felt like a suspect that was holding hostages.

And I got this phone call from one of our Superintendents, who said, “Whatever you need right now, I’d be happy to help you.” And I said, “Come over here, and get these press people to get away from my house.” And he is working on medical malpractice for us and a number of areas in which of course health care coalesces with insurance. I speak of Superintendent of Insurance Eric Dinallo. Thank you for joining us.

We give health care to all people in our state, and we are distinguished for it. We have some of the greatest health care facilities. We’ve trained the best doctors. We have tremendous yield in terms of our health care area and profession and we treat everyone from dignitaries to the destitute. We are able to find a way in spite of all kinds of bureaucratic and often the intervention of other aspects of living imposing on us. We are able to achieve.

All of your know that there is probably no better health care than at Mount Sinai Hospital which is on the Upper East Side. And yet just twenty blocks north of there in East Harlem, and in Central Harlem and in West Harlem 25 percent of the young people suffer from chronic asthma. Some of them have had 40 hospitalizations to this point. Many of them receive up to five different medications a day and all of them at some point miss great school time so it interacts with their education system.

We can go further down on the East Side and find NYU Medical Center and Bellevue—some of the greatest care you will ever receive—but if we go further down the Lower East Side, we can go to the Ryan-NENA Community Health Center where 30 percent of the people are actually uninsured. Four hundred thousand children in the state are currently uninsured—more than the populations of Syracuse, Rochester and Binghamton combined. We could put them all in those cities and take the place of those who live there and none of them have any health care insurance.

If we go up on the West Side up into Washington Heights we find Columbia Presbyterian Medical Center and also Columbia School of Medicine. I was diagnosed there with optic atrophy in 1956 and declared legally blind. They have given great service for over a century, and in that regard, it is stunning to find that right across the river in the Bronx, we have communities like Mott Haven and Morrissania where there are 3,500 people for every doctor.

So we give great health care. New York is outstanding in that area and yet with all that we’ve done and all that we’ve achieved we are 39th in terms of the prevention of hospitalization. We are in the lower half of the country’s states, in terms of keeping people out of hospitals based on chronic medial situations such as diabetes. We are also in lower third of the other states in terms of ambulatory care.

Not this is in now way to suggest that our health care systems or anyone else is responsible for this. We actually have delivered the greatest health care in this country.

But the problems are so seemingly insuperable, it must be a moral conscience-raising exercise to try to talk about these issues when we continue to strive for perfection, and yet the obstacles seem to be as insurmountable as they actually are.

And that’s why I think that the great partnership that this association has been able to derive with the hospital workers, with people from government, with other health care institutions around the country is nonpareil. I have honestly not seen an institution reach out to more people in more places to try to improve when it already gives excellent care.

Rather than standing back and marveling at the work that you have done you have continued to go forward and reach out to individuals. And right here in New York State we have dared to try to have individualized care. We’re not going in the direction of California, with whom we are compared unfavorably in terms of Medicaid reimbursement, when California reimburses through its agencies and not through its regular government and so therefore it’s an anomaly and can’t even be compared.

But we’re not trying a “one-size-fits-all” approach. We’re trying an approach that is a benefit to all patients. And we know that all patients don’t require the same remedies. Often it is a customized care for which we are striving. And this association partnered with us in this last budgetary process, in some respects to your own detriment but doing it because of the lives we may save and the costs that we may be able to inhibit. And so for that reason we were able to work together to begin to address the ambulatory care problem by devoting $340 million to ambulatory care in this budget that was just passed a few weeks ago.

In addition we are looking to change the patient care and patient costs, trying to bring them more in line with the hospitalization costs, or medical reimbursement—or rebasing for short. This is a difficult undertaking; this required tough choices; this required an article of faith because we think this is the right way but we don’t know the future. But you were willing to join with us even at some sacrifice to put this program into fruition. And we will have a working group so that we will measure the success or failure of it because what I want you to know about this administration is that we are not afraid to fail. We are going to continue to try until we find better solutions to our inpatient care and hospitalization rates here in New York State.  [Applause]

We are very concerned about the availability of doctors around the state. I talked a minute ago about the problem in the South Bronx. We have a statewide system we are trying to implement called Doctors Across New York. We’re putting resources in so that student loans and other costs will inure to the benefit of those doctors who are willing to go serve in underserved areas. This is extremely important at a time when the availability of health care, particularly in the rural areas of the North Country, areas like Lewis County and Jefferson County and Oswego County...when the availability of health care, even way out on Long Island...and the availability of health care even in some of the inner city areas of New York, require the kind of physician care that we will try to provide from this actual purpose.

We recognize in this budget that we were able to cut Medicare costs. We’re cutting Medicare costs through the elimination of fraud. In the year 2006, that ended in 2007, we cut $300 million in relief of fraud out of the Medicare system. This year we have almost doubled it in two years, we have been able to save $590 million that we have been able to recover from the investigation of fraud in the actual system. And this is something that also enabled us to recover 75% of the cost savings that we wanted to achieve from the Medicare system and we could not have done that without your assistance.

So these are some of the areas we were able to address in our budget. We were able to do it through partnership. We were able to do it through a sense of cooperation. And that is the only way a government can actually serve the constituents that it purports to represent.

But we don’t want to stop there. We want to go forward and look at some of the needed areas that we must address. And obviously the one that is a priority of mine has to do with my first day of service – December 8th, 1985. It was so long ago, I can’t even recall the date! That day I went to a special session in Albany having been elected in a special election in 1985. The first debate I ever heard was about medical malpractice. This issue is one that must be addressed. It’s not helping physicians, it’s not helping patients, it’s not helping providers and it’s not helping anyone to continue the system that we have now. And this is why we have asked Superintendent Dinallo and Commissioner Daines to work on this issue because we want to come back with some recommendations. There obviously is no solution to this problem that will not requite tough choices, but this is what we are in now, an era where we are going to have to make tough choices in that regard. We are continuing our desire to assist people in this state by taking a new look at how our health care system can impact on individuals.

And so that’s why I come before you today. Not only to thank you for what you’ve done, but to ask for your help because we have another storm brewing that doesn’t have anything to do with health care, it has to do with the failure of our national economy.

Right now we have 9 million homeowners who are paying their mortgages where the mortgage value is greater than the value of the home. No one can remember this ever happening in the history of this country—where the housing rates are down for the first time since World War II, where that 9 million number will be twice that in three years, where we lost 95,000 jobs in this country losing private sector jobs for the fourth straight year and anticipated greater loss in terms of the growth of the economy.

This particularly impacts upon New York because Wall Street provides 20 percent of our overall resources. And so therefore it was stunning to me to find out that in March we collected $72 million from the 20 largest taxpayers—corporations and banks—$72 million that they paid in taxes. These are taxes on their earnings for the fourth quarter of 2007. In March 2007, one year ago, these same 20 tax payers paid $533 million to the general fund of New York State. In other words, we recovered only 14 percent of the revenue that we were able to recover one year ago.

This is going to impact on every aspect of our lives; this is going to impact on the operation of government; this is going to impact on the distribution of health care. And this is a problem that is going to coalesce with our attempt to bring quality, affordable and preventive healthcare to the people of this state.

Because of this, we are going to have to learn how to thread the needle in terms of adjusting and cutting back, and growing our local economy, in a way that we can withstand what may be huge losses in revenue protection over the next couple of years.

But at the same time, we have to remember what the fore-parents of New York always endeavored to do in times of crisis: they addressed the crisis, but they did not let go of their dreams.

They were willing to make the tough choices, but they also saved a little to try to think to the future and move into national leadership in economic development, in housing, in education, and in the distribution of health care.

We will not make the mistake of putting all our resources on problems and not looking to the future—so that when we get out of this recession, whenever that is, we will be in a place where the rest of the country will come here to learn about health care, to learn about its distribution, and to learn how we have solved some the myriad of problems that seems so insurmountable to us now. Because obstacles are really only the barriers that we imagine exist between us and our goals.

We can provide decent and affordable health care to people. We can provide primary and preventive health care to the young people in our society. We can make sure we have better public health programs that address the issues of individuals who have issues as they address their senior status in life.

But we can do it only one way: by working cooperatively and collaboratively to bring a viable understanding that all of us have a unique perspective in the system—whether we run the hospital, whether we work in the hospital, whether we have been hospitalized. And this is our desire: to bring those forces together, and those vectored quantities can bring together, what will be, in my opinion, a new paradigm in delivering health care. We want it to be accountable, and at the same time, individual. These are often seemingly opposite perimeters of the spectrum, but in the end, they connote the goal that we actually seek.

So to all of you at the Greater New York Hospital Association, for all of your great work over the years, for your partnering in ways that revolutionized the relationship between employee and management, between private sector and public sector, between hospital administration and the doctors that work there, and between administrations and each other to develop renewable forms of health care delivery: I want to thank you.

And I want to pledge to you that this administration is a partner with you in an effort that I hope will be a prelude to a time where we can come back and say, that not only did we have severe health care issues in the first decade of the twenty-first century, but we had economic problems. And somehow we solved them the same way our ancestors solved the myriad of problems that we read in our history books now.

Thank you very much for having me this morning.  [Applause]