In my previous post, I presented a spreadsheet of local government employment and payroll data from the U.S. Census Bureau, along with some related private sector data from the Bureau of Labor Statistics, and explained why and how it was compiled. In this post, I will once again go through some of the highlights showing how New York City and the rest of New York State compare with the national average and New Jersey, in this case in health care and education employment. Once again I stress that just because something is the national average doesn’t make it right, but substantial deviations need to be explained and justified. Here in New York, they are not even admitted. That is because state government, which created many of the priorities seen in local government data, is completely dominated by producers of public and publicly funded services, and has enacted one policy after another to ensure that less is received in exchange for more.
Why local government? The federal government collects the most money, but it sends most of it right out again in payments to the health care industry, aid to states, Social Security, and interest on the debt, and actually does little other than national defense and the Post Office. Direct services provided by states are limited, primarily state prisons, universities, mental hospitals, parks and unemployment and workers compensation insurance. Local governments and certain government-dependent private industries do most of the work of government, but under rules set and with substantial funds provided by state governments. So while the data is on local government, the issues are in large part state issues.
Lets start with the two funding recipients the New York State Legislature says cannot be cut, even if the state runs out of money: education and health care. New York City stands out as having 597 public hospital workers per 100,000 residents. The national average is 192, the rest of New York State is 118, and New Jersey is just 28. Does this mean that the city is more reliant on public rather than private hospitals, just as it is more reliant on public transit rather than auto dealerships and gasoline stations? No. The city also has 1,801 private hospital workers per 100,000 residents, compared with a national average of just 1,506. The rest of the state and New Jersey are also above average at 1,724 and 1,655. It may be the case that those from elsewhere are coming to New York City for hospital care, and this explains some of the excess employment, but the available data show there is plenty of hospital employment in the rest of New York State and New Jersey as well.
To explain high employment in the hospitals industry, look to the priorities of New York’s Medicaid program, which are set by Greater New York Hospital Association and Local 1199 through the state politicians they fund. They want extensive funding for hospitals, and less funding for primary care. New York City had 569 people employed by Offices of Physicians, compared with 741 nationally, 845 in the rest of New York State, and 790 in New Jersey. And New York State has 135 employees of Outpatient Care Clinics per 100,000 residents, compared with 175 nationally, 203 in the rest of New York State, and 178 in New Jersey.
Another set of Medicaid choices concerns spending by age. Past reviews of state-level data from the Center for Medicare and Medicaid show that New York spends somewhat more than the national average per recipient for children eligible for Medicaid, but vastly more for senior citizens eligible for Medicaid, and has far more seniors on Medicaid than average as a share of its population. It also shows that New York State spending on nursing home care is high by national standards, even though spending on at-home services, designed to reduce nursing home costs, is very, very high. (Looks like 42 of 50 states have sent the Medicaid Statistical Information System accepted data for 2008; I’ll compile it when it hits 50). The employment data shows the effect of this on New York City as compared with the rest of the state.
The data show that New York City’s employment in the private Home Health Care industry is 725 per 100,000 residents, compared with a national average of 315, and an average of 320 in the rest of New York State. In the Services for Elderly and Disabled industry, part of the Social Assistance sector, New York City had 977 employed per 100,000 residents, compared with a national average of 192 and 329 in the rest of New York State. This industry consists, for the most part, of persons providing at home care other than medical care (cooking, cleaning, etc) to senior citizens, generally under the “personal care” category of the Medicaid program. For years New York State has accounted for a huge (though slowly shrinking) share of national Medicaid spending on personal care, with most of this clearly in New York City.
So how has all this employment in at-home care affected nursing home employment? In New York City, where employment in at-home care industries is sky-high, employment in the Nursing Homes industry, at 833 per 100,000 residents, is below the national average of 990, but not nearly enough to offset the higher employment in at-home care. And in the rest of New York State, where employment in at-home care is average, employment in the Nursing Home industry is sky-high at 1,451 per 100,000 residents. “As luck would have it” in New York local governments have to cover only 10 percent of Medicaid spending on nursing home care, which is concentrated outside New York City, but 25 percent of Medicaid spending on at-home care, which is concentrated in New York City. One of a zillion similar differences.
This is private employment data, not New York government spending data, and thus reflects not only Medicaid spending but also all the services that Medicare pays for, and private insurance pays for, and people pay for themselves. New Jersey is a wealthier state, so one would expect Medicaid’s share of total spending on senior services to be lower. But the amount of employment in those services is lower in New Jersey than in New York overall, with Nursing Home industry employment slightly below the U.S. average at 966 workers per 100,000 residents, Home Health Care industry employment about average at 347, and Services for the Elderly and Disabled employment far lower at just 111. Are senior citizens therefore suffering deprivation in New Jersey? If not, what explains the differences?
Data like these is enough to make one less than pleased by statements made by Senator Schumer on the Senate health care reform bill. The bill was criticized by New York politicians, who claimed that the higher costs shifted to New York relative to other states would lead to higher mandated spending on health care overall (taken from other services) and lower spending on clinics and preventive care within health care. “The legislation does benefit New York in certain ways, Schumer said, such as providing funds to the state’s teaching hospitals and exempting certain Medicare Advantage programs where payments go to patients rather than insurance companies,” Bloomberg.com reported. In other words, New York received special consideration for its senior citizens and hospitals, trading away other needs. “Every state has its own unique situations,” according to Schumer. Different situations, or different distributions of campaign contributions and influence?
I want to see the evidence that more employment in hospitals and less in physician’s offices and clinics has made New York City residents healthier, and more employment in industries that provide care to senior citizens as the end of their lives has made those seniors better off here than in New Jersey.
Let’s move on to education. Past data has shown that New York City’s employment of public school instructional workers was low relative to its population, and public school non-instructional workers was very low, while New York State’s employment in those categories was high and very high. The current data shows New York City has closed the gap in instructional to an extent, with 1,463 instructional public school employees per 100,000 residents, compared with 1,575 for the U.S., 1,995 for the rest of New York State, and 1,907 for New Jersey. New York City’s gap is now entirely explained by its residents’ higher propensity to send their children to private school. Its private elementary and secondary employment equaled 428 per 100,000 residents in 2008, double the 216 in the U.S., and more than the 324 in the rest of New York State and 287 in New Jersey.
New York City teachers were also poorly paid, relative to the national average, once the national average was adjusted for. In 2008, however, the March 2008 payroll per full time equivalent instructional employee for New York City was 21.0% above the national average; the average New York City private sector worker, excluding the finance and insurance sector, was 30.9% above average, a much smaller gap. New Jersey’s instructional workers earned 35.4% more than average; those in the rest of the state, including low-cost Upstate New York, earned 23.8% more than average.
Data on total spending per student from another database, however, shows that New York City teachers’ total compensation is now as higher or higher than the suburbs, New Jersey, and Upstate New York, even with a cost of living adjustment. That is because in New York City more of that spending is for the retired, rather than higher pay for teachers or lower class sizes. That was true in 2007, and I expect it to be true going forward as well.
In the non-instructional category, New York City remains lower than the national average in employment, at 283 per 100,000 residents compared with 684, while the rest of New York State remains high at 967 per 100,000. Some of this may be explained by contracting out – the high average pay of New York City instructional workers implies more managers than workers. But data on spending shows that New York City’s non-instructional spending per child is also very low, while the rest of New York State remains very high.
Under the Census Bureau’s classification system, state government higher education is public colleges and universities, which tend to be state run, and local government higher education is to be community colleges, which tend to be locally run. One of the possible avenues of escape for New York City’s children as its public schools collapse over the next few years is for those who can afford to pay to head for community college instead of a senior year of high school. But New York City’s instructional community college employment at 37 per 100,000 residents is lower than the national average of 44, and community college students have trouble getting into classes, or so I’ve been told.
Even more alarming, in every area community college instructional employment is lower than non-instructional employment, which makes them seem more like jobs programs for janitors than institutions of learning. It may be, however, that the large number of part time adjunct professors and instructors are counted as independent contractors (self employed) and not reflected in the employment data. Someone should look into this issue. Higher education, it seems, everywhere reflects the feudal tendencies of feudal New York. You have “full time” professors with full benefits, tenured so they can’t be fired, who teach two courses per term and are otherwise free to do research (such as what I’m doing here in addition to my full time job), and “part time” adjunct professors who teach five courses per term at three different institutions without benefits, and can be fired if they do not perform. Are the full time professors deserving of their leisure because they are better? In that case, why are those who are better teaching less than those who are worse?
Over the next three years, we will be presented with a choice. Raise the nation’s highest state and local taxes even higher, or settle for drastically fewer workers providing drastically less in public and publicly funded benefits. No doubt the state legislature will do both, and perhaps Local 1199 and the Greater New York Hospital Association will make good on its threat to let our babies die while the United Federation of Teachers informs its members they can no longer be expected to teach. But remember this – going into this period, New York’s employment in public and publicly-funded education and health care was high – high in home health care, hospitals, personal care aides in New York City, high in nursing homes and public schools in the rest of the state, and high overall. Some might ask the question why New Yorkers have to pay more and settle for less, rather than having a more typical number of workers produce health and education of reasonable quality. Neither raising taxes, nor cutting services, nor deferring costs or advancing revenues should be credited with political courage or sound management in New York. We do not deserve to pay more or accept less. We should be getting as much, even with fewer employed, in education and health care.