With 1199 S.E.I.U. United Healthcare Workers East and the Greater New York Hospital Association running commercials attacking Governor Spitzer’s relatively small increase in Medicaid spending, and these commercials featuring nurses, I became curious how New York City’s nurses, and other health care workers, were faring relative to their colleagues elsewhere in the country. Curious enough to download and compile Occupational Employment Data from the New York State Department of Labor and U.S. Bureau of Labor Statistics. After their nearly 20 years of ruthless pursuit of unenlightened self-interest with total indifference to other priorities and needs through naked political power, nothing I could find here would make me feel better about these interest groups. If the employment level, adjusted for population and overall employment, and average annual pay, compared with the average overall, for workers in health care occupations were above average, I would be upset that the rest of us were funding these excesses through higher Medicaid spending. If they were below average, on the other hand, I would be upset that we were paying so much more for Medicaid and yet our health care workers were understaffed and underpaid. And if they were about average, I would be outraged that Medicaid, a program for the poor, was being overcharged so private health insurance for the wealthy could carry less of the load. So they are guilty. But the data can help show what they are guilty of. It is attached, and described below.
For those not familiar with economic concepts, an industry is a type of business, like the Hospital Industry, while an occupation is a type of work, such as the Doctors, Nurses, Orderlies, Clerks, Managers, and Janitors who work in hospitals. Using industry data, I’ve already shown how overall New York City employment, relative to population, is very high for Hospitals (both public and private), for Home Health Care, and for the portion of the Individual and Family Services industry that involves personal at-home care for the elderly. I’ve shown that average pay is just average in Hospitals, once overall wage levels and the cost of living is adjusted for, and below average in the home care sectors. The occupational data is based on a lower sample size, and is less complete. Moreover, we can’t find what the level of, say, clerical staffing and pay is in health care, because the occupational data is provided for all clerks industries. For larger health care specific titles, however, the data is illuminating.
I’ve also pointed out that excluding the massively paid finance industries, workers in Downstate New York earn about one-third more than the national average. This figure tends to correlate with our higher cost of living (in normal times, not housing bubble times), meaning any worker would want to earn that here to not be worse off than the national average. The Occupational Employment data provides a median wage, which for all workers in New York City is 36.6% more than the national average, while in the broader New York Metropolitan area, including the lower Hudson Valley, Long Island, New Jersey, and part of Pennsylvania, is 24.1% more than the national average. This is consistent with those in Downstate New York earning one-third more than the national average, as I have found using industry-based data, excluding finance, from other sources.
Given that, how did New York City’s nurses fare? With 2.8% of the nation’s population and 2.7% of its jobs, the city had 2.9% of its Registered Nurses (with 69,690), just a hair above average. And these nurses earned a median $72,340, or 32.3% more than RNs in the nation as a whole, or almost exactly what might be expected. The city’s Practical and Vocational Nurses fared somewhat less well, with the 16,100 of them accounting for just 2.3% of the national total, and their median earnings of $42,200 just 19.8% above average. Still, it would appear that nurses have nothing to cry about.
Life is a little tougher for New York City’s Home Health aides, who earn a median of just $18,900 or 0.5% more than the national average, and its Personal and Home Care aides, who earn a median of just $20,050 or 15.6% more than the national average, despite the higher cost of living here. But that doesn’t mean the rest of us don’t pay a lot for them, because they are so many of them – 10% of the national total for the former, and 7.2% of the national total for the latter. New York’s elderly, and perhaps others, are clearly using home care and personal assistance far more than those elsewhere in the country – in addition to our above average reliance on nursing homes. This confirms the industry data, and the Medicaid spending data, in that regard.
Governor Spitzer might know of a hospital where the top three officers earn $12 million between them, but the typical health care administrator in New York earns a median annual wage of $63,220, or about 27.5% more than the national average. That is a reasonable amount. But like the home care workers, New York has an unusually large number of Medical and Health Services Managers, a total of 11,320 or 4.9% of the national total. So it’s no wonder the ads don’t feature health care managers.
Perhaps the Physicians should be crying. New York City has only 1,500 Family and General Practitioners, just 1.3% of the U.S. total, and their median annual wage of $131,070 is actually 6.6% lower than the U.S. Average. New York City’s 750 pediatricians are 2.8% of the U.S. total, but their median annual wage of $102,630 is 24.9% lower than the national average. Most New York City physicians are in specialties – the 15,980 Other Physicians and Surgeons in he city account for a whopping 8.9% of the national total. But as for home health care workers, large numbers does not equal large pay, with the median of $103,000 a stiff 28.9% lower than the national average here in high-cost New York. It should be noted that while New York State’s Medicaid spending per recipient is far higher than average for Hospitals, Nursing Homes, and many other services, its spending per recipient for Physicians services is low. Many, therefore, refuse to take Medicaid.
On the other hand, New York’s Nursing Aides, Orderlies and Attendants have reason to celebrate: their median wage of $32,030 is 49.4% higher than the national average. These folks, ably represented by Denis Rivera, weren’t chosen for the commercials either.
Something needs to be said here. Over the past 30 years, private sector pay has soared for those with high levels of education or other specialized skills, and stagnated for those who are not highly educated or skilled, opening an enormous gap. Not everyone believes that is fair, so in the public sector, where change comes slowly, those with lower skill and education levels continue to get paid far more than their private sector counterparts, while those with higher education and skill levels, and managers, get paid less. One reason the government contracts out, in fact, is to get around this in both directions – hiring consultants to get more qualified experts at higher pay, and hiring contractors to save money on less skilled workers earning lower pay and benefits. That is in addition to, or depending on your politics instead of, any efficiencies the private sector may have.
It is at least possible that, if all the fact were out in the open, given that health care is a substantially government-funded private industry, and accepting the possible costs in money and patient care, the City and State of New York would have decided to pay Physicians less than average (since their pay is high even at that) and orderlies, nurses aides and attendants more than average (since their pay is below average in any event). If all were out in the open, however, the sacrifice made by Physicians would be acknowledged, and the good deal for orderlies, aides and attendants (and, in terms of numbers and the highest paid, administrators, numbers) would also be acknowledged. So would the sacrifice of taxpayers, and other interests and priorities. There would be an open discussion whether only education in New York City should be sacrificed, and only taxpayers without special tax breaks should pay the additional cost. And perhaps, in gratitude, New York’s orderlies, aides and attendants would feel a special obligation to work extra hard, allowing us to get by with fewer of them.
As it is these decisions were made in back-room deals, all at public expense. And the 43,770 Nursing Aides, Orderlies and Attendants working in New York City are 3.1% of the national total, more than would be expected based on the city’s share of overall population and employment, though perhaps not given the city’s high reliance on institutional care. And are these the most motivated, caring Nursing Aides, Orderlies and Attendants in the country? I won't relate anectdotes; people can decide for themselves.
Getting back to the nurses, however, what we have is pretty much what you’d expect, no more and no less, despite how much more in taxes we pay for Medicaid financed services, and the high priority of health care relative to other public priorities. It isn’t the nurses, therefore, that should be crying. It is the rest of us.