Medicaid: Parsing The High Cost Per Recipient (Second of Three)

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As I reported here, in 2003 New York State was charged $7,912 per Medicaid beneficiary, 76% higher than the national average of $4,487 and more than any other state.  This is not a surprise, as New York has had the highest Medicaid spending per recipient as far back as I have collected data.  And, I once read a paper that described New York State’s Medicaid program as being vastly more expensive than other states in the early 1970s, less than a decade after the program was created.  In fact, I saw a film on the Channel 25 “City Classics” program showing a press conference by former Mayor Abe Beame, who was bemoaning the fact that Medicaid spending was out of control and seeking to use city resources to combat fraud to stop it.  The state had no interest in doing so, Beame said, because it could simply force the city to pay.

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NYC Demography: A Stunningly Rapid Change

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I’ll have to interrupt my series on Medicaid, which was delayed by a computer problem at home, to call your attention to recent data from the American Community Survey.  The data on educational attainment, written up in today’s Times, is in fact shocking.  I say that as someone who has looked at similar data over long periods of time.  It’s not so much the direction of the change, which corresponds with what I see on the street, but its scope and speed.

The share of the city’s population that is high-school and college-educated is soaring; the share that has not completed high school is plunging.  This cannot be the result of the educational attainment of those who comes through the city’s schools:  the state’s policy of making the life-chances of the city’s children even worse that it would otherwise be has thus far succeeded.  Rather, it is a function of who is moving in and who is moving out or dying off.  The former are better off than the latter, and the population turnover appears to be rapid.

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Medicaid: Exceeding the Unlimited Budget (First of Three)

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When asked at the end of the1974 season why he was replacing his general manager, the owner of the Houston Oilers football team replied “I gave him an unlimited budget, and he exceeded it!”  The same may be said of New York State’s Medicaid program.  Its budget is unlimited – its cost goes up by whatever it does every year, and taxes are raised and other services cut to make up the difference. Medicaid, along with debt service and pensions, get the first, second and third bites of the apple.  (Public schools in the portion of New York State outside New York City get the fourth.)  And when the cost of Medicaid is restrained, as in the mid-to-late 1990s, it is by reducing the number of beneficiaries who receive health care benefits, not by restraining the increase in what the health care industry decides to charge.  The number of people employed by that industry in New York, fueled in large part by government money, rises rapidly each and every year.  With just 6.5% of the nation’s population, New York State accounted for 15.1% of its Medicaid spending (see attached spreadsheet).

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Her Smile May Be More Important Than Your Life

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I received some good news about my daughter’s future orthodontist bill recently.  Good news for me that is, at least in the short run.  My wife’s dental insurance will cover part of the cost.  While that insurance is part of her salary, it does not count as taxable income, and is thus exempt from federal, state, local and social security taxes.  And, we’ll be able to put aside money on a pre-tax basis to cover the balance, under a plan she has at work, with a similar exemption from taxes.  My wife works for a quasi-public agency.  The government, therefore, will end up paying indirectly (through the tax break, and through private dental insurance purchased on her behalf) for about $3,000 of my daughter’s improved smile.  The same government, that is, which (unlike the government of virtually every other developed country) doesn’t provide universal insurance for at least basic health care.  If you aren’t a senior citizen, don’t have health insurance provided by your employer, cannot afford an individual policy, and are thus uninsured, her smile – which you are helping to pay for – may thus be more important to our elected officials than your life.

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Chasing the Metal Rabbit

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How much more would the federal government have to spend on health care to provide universal health insurance?  How much more would New York State have to provide in state education funding to provide every New York City child with a qualified teacher and an a national average class size?  How much more would the MTA have to borrow to build long promised improvements such as the Second Avenue Subway?  Now imagine you were asking these questions in the early 1990s, when former President Clinton held up a card and promised universal heath care and the Pataki, Silver and Bruno era began in Albany.  What numbers have you arrived at?  Chances are, that much and more has been borrowed and spent since.  But like a football held by Lucy Van Pelt, these benefits have been pulled away at the last moment, and the money has gone elsewhere.

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Property Taxes: Corzine Has It Easy

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You may have heard that New Jersey Governor John Corzine has called a special session of the New Jersey State legislature to tackle the “intractable” issue of high New Jersey property taxes.  He plans to reduce pensions and benefits for new employees, to offset the cost of the pension enrichment for those cashing in and moving out, and borrowing against the pension funds, passed during the Whitman Administration.  He plans to try to entice, or force, New Jersey’s high-spending school districts to consolidate to cut costs.  And, he plans to raise other taxes, perhaps at the state level, to offset a property tax decline.  Those are tough stands. Compared with the next Governor of New York, however, the fact is Corzine has it easy.

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The Losers

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In several past posts, and in several future posts, I’ve discussed the winners, those categories of services and people who get far more public funding here than the national average, in some cases more than in anywhere else in the United States.  But despite state and local taxes that were 43% higher than the national average in FY 2004, relative to personal income, and lots of fee income besides, taxpayers are not the only losers in New York City.

Spending on the city’s public schools has been below national average as a share of income, often far below, as far back as the data goes.  Parks, recreation and culture had been above the national average until1989, Ed Koch’s last year in office.  It has been far below average ever since, despite lots of private donations.  Major transportation projects are proposed and planned, but never built here.  Yesterday, the Daily News reported that the city’s libraries are rarely open.  http://www.nydailynews.com/front/story/441273p-371556c.html.  No surprise there.

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Man’s Rules Bite Dogs

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It’s time to admit it:  like just about everyone else in New York City, I’m a criminal, but my life of crime may be coming to an end.  My particular crime:  allowing the kids’ dog off leash in Prospect Park, during the designated hours listed on the park’s website.  How is that a crime?  It is a crime because New York City has an ordinance on the books that says at all times, and in all places, all dogs must be on a leash no less than 6 feet long when in public.  No exceptions.  No exclusions. 

When off leash hours were established, the city didn’t bother to change that ordinance.  It decided instead to not enforce the ordinance during certain hours.  It decided, in effect, to make me a guilty criminal, but to let me get away with it.  Now some folks out in Queens who don’t like off leash hours have filed a lawsuit.  It’s goal?  To force the city to enforce its own laws, and ticket those who allow their dogs to be off leash.  Who could argue with that?  I will argue against the city’s original decision to avoid changing the ordinance, and as part of general principle of law and ethics rather than as a specific canine case.  This is a long post, but if you are interested but that bothers you, you can copy it, paste it, and print it out.

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Scrutinizing Sanitation

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As I recall from high school Latin, “scrute” is trash, and the word scrutinize, from which it is derived, means to pick through the trash.  Using data from the Governments Division of the Census Bureau, and the New York State and U.S. Departments of Labor, this essay will pick through the trash at the NYC Department of Sanitation to find out what kind of deal we are getting.  That isn’t as easy as for, say, schools and policing, which are provided in every locality, because not everyone has public trash collection.  But I did the best I can, and from what I can see, our deal stinks.

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Sweating Out Kyoto

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It’s over 90 degrees as I sit here, and I’m thinking about energy, the environment, and leadership.  If you read my prior post on the subject, you know that I believe leaders are those who can convince people to cooperate toward a common goal, trusting that their goodwill will not be abused by those who are just out for themselves.  I said there was no leadership on energy.

We don’t have air conditioning because in this climate, unless you have it and become dependent on it, you only really miss it a few days a year a few years a decade.  And on those days, you are begged not to use it.  With energy scarce and the environment only capable of holding so much carbon, with with so many billions living in multiple dwellings without cross ventilation, with so many people who are old and without health problems, I’ve decided air conditioning is one amenity we can live without.  But somewhere in the west, I’m sure Dick Cheney, who considers conservation a “personal virtue,” has an air conditioned dog house.

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