A Few More Health Care Notes

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When Eliot Spitzer provided a one-word “yes” answer to the question of whether he would bring about universal health care, I can only hope that he meant he would do so someday as President, not as Governor.  After all, providing health care for every severely ill person in the United States without health insurance would be a big burden on the New York State tax dollar, perhaps leaving no money for anything else.  And as a result of a Supreme Court decision in the wake of welfare reform, which held that any benefit offered to state residents must also be offered to everyone else, that is exactly what would happen.  Anecdotal evidence suggests this happens, to an extent, already.  Still, while I believe a universal health care financing system must, and should, be implemented on the federal level, there are some things a New York State Governor could do to bring it about.

What I Would Do About State Education Funding

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This essay will talk about state school funding and the Campaign for Equity Lawsuit.  But before I describe what I would consider a fair system, after a root-and-branch reform, let me give you the bottom line.  Under New York State’s Reverse Robin Hood system, New York City’s share of front door and back door (STAR, son of STAR, anything else they come up with) state education funding is not only less than its share of the state’s public school children but also its residents’ state income tax payments.  This must end.  Argue all you want about whether educational resources should be redistributed to poor children; it is an outrage that for 30 years they have been redistributed away from poor children.  And the level of public school spending, staffing and pay in the rest of New York State is far too high, which is unfair to local taxpayers, to New York City’s schools which get outbid for qualified staff, and to New York City taxpayers who are increasingly expected to accept an even lower share of state education funding to pay for it.  The practice of giving more state school aid, under STAR and similar programs, to those who spend the most must end.  The fact that spending in the rest of the state is so high, that New York City’s children have been sacrificed to pay for it, is what no one is willing to say.  I’m saying it, and demanding that it stop.

What I Would Do About Medicaid 2: The Family of Last Resort Problem

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One of the reasons New York spends more on Medicaid is because the health care industry uses its political power to charge more, the subject of my prior post. A second reason is it charges for services it does not actually deliver – Medicaid fraud. A third reason is that New York provides more Medicaid services for recipients than do other states. And as I wrote here, the beneficiaries of most of those additional services are the elderly.

Today’s American elderly are the best off people, with the easiest lives, in history – unless one counts slave-owners. Tomorrow’s elderly, those born after 1955 or so, will not be as fortunate. Entering the labor force after social security taxes were raised, on the wrong end of multi-tier labor contracts, without defined benefit pensions and perhaps, when they reach their 50s, losing health insurance as well, and with limited savings, today’s young and middle-aged will reach old age as social security funds begin to run dry and the debts run up by their predecessors must be paid. We will have to work until no longer able, and will then face poverty. The poverty rate of the elderly, much lower than that of children in recent decades, is likely to explode – unless the seniors use their political clout to tax their own children into poverty, or to wipe out public education, or otherwise do unto their offspring what was done to them.

What I Would Do About Medicaid: Part 1, Prices

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What I would do about Medicaid is not what I would do about health care.  In my view, because those in need of expensive care, and those who do not want to pay for them, are free to move across state borders, health care is a national problem with a national solution (see here).

Any state that attempts to provide universal care for its residents will end up providing universal care for all Americans – until its economy collapses and it provides nothing to anyone.  With regard to Medicaid, my goal is to avoid having the health care industry – with its political power and indifference to the consequences of its increasing demands – from destroying other public services and the economy of the state.  Medicaid, for me, is a fiscal issue, not a health care issue, and my goal is to continue to get necessary health care without paying twice as much as everyone else.  That is different from the current fiscal goal – to pay as much as possible in for as little as possible in exchange for political support.  The current situation is a product of incentives – the state government gets to hand out money to its supporters, but other governments are forced to pay much of the cost and impose much of the sacrifice.  My proposal is to change the incentives.

Prepare the Rotten Tomatoes

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Since I’ve been asked to write for this blog, I’ve delivered a litany of (primarily) fiscal complaint, a series of objections to the ongoing and expanding advantages grabbed by powerful interests in Albany (and elsewhere) at the expense of the private sector working poor, the young, the future, and New York City’s children.  But I try not to make complaints unless I have what I believe are at least partial solutions.  So for state government, and for the month of October, I’m going to provide some.

They won’t make many people on the inside happy.

Don’t Forget the Fastball

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I once heard Tom Seaver, providing color commentary on a baseball game, describe some advice a pitching coach had once given him. “What’s the best pitch in baseball?” the coach asked. “The fastball,” he said. “What’s the second best pitch in baseball?” he asked again. “The fastball,” he once again answered his own question. His point, Seaver said, was not to forget the fastball. Major league pitchers know they need a good second pitch to succeed, so often they focus on their off-speed pitch, whether a curve, slider or change-up, to the exclusion or near exclusion of the fastball. And that’s a mistake, because it’s the fastball that makes the whole thing work.

Upstate: The Search for Suckers

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As I wrote here, one of New York City’s biggest economic problems is a shortage of jobs accessible to the unskilled, and thus its low level of employment and labor force participation. In many ways, Upstate New York is the city’s mirror image. It has a lower poverty rate and a higher employment rate, but it has a shortage of high-paid jobs and jobs for young college graduates, the very economic base New York City – primarily Manhattan – has in abundance. Among those growing up Upstate, the average person completing their education probably has more of it than the national average. It is migration – the type of people who move out, and the type of people who don’t move in – that is responsible for the fact that the share of Upstate residents with college diplomas is lower than in the rest of the state. Upstate college graduates, and those with exceptional non-scholastic skills, tend to leave, and few arrive from elsewhere. That is the real problem in Upstate New York.

What Seymour Lachman Didn’t Say

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I paid a fairly substantial sum to read former State Senator Seymour P. Lachman’s Albany expose Three Men in a Room. The book is a good summary of what those of us who have been reading the newspapers for the past few years already know, with the added benefit of having a former insider confirm than the worst accusations of the outsiders are correct. For those who haven’t been following the descent of our state government into despotism, I recommended it; you in for a big surprise. Hopefully, after all the libraries have made their purchases, Mr. Lachman can convince his publisher to put out a cheap paperback edition, which his education contacts can substitute for existing textbooks in the New York City public schools, those that falsely assert that we live in a democracy. But before that happens, there are some things I’d like Mr. Lachman to add.

Governor’s Island 4.0

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The news broke earlier this week that the latest planning process for the redevelopment of Governors’ Island has been scrapped, and the agency charged with the redevelopment of the island would start over.  Again.

The latest plans called for a variety of uses, including hotels, condos, conference centers, and an amusement park.  Mayor Bloomberg’s earlier plan called for moving the CUNY campuses there, and using the existing campuses for public schools.  Mayor Giuliani’s plan called for a casino.  The next failed plan, which will no doubt provide positive publicity (and that is the point isn’t it?), will be the fourth.  Under the circumstances, you may be interested in what I suggested, while working at the Department of City Planning, when the first plan was being cooked up – moving the United Nations and all related embassies to the island.  That proposal may be read after clicking “read more.”

Woe is Upstate (Phony/Exaggerated Problem 4 of 4)

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For a decade or more the status and needs of Upstate New York’s economy has been the number one issue in virtually every statewide political campaign.  In 1994, Republican George Pataki unseated his predecessor as Governor, Democrat Mario Cuomo, in part by blaming Cuomo for Upstate’s economic decline.  In 1998, Democrat Chuck Schumer unseated his predecessor as Senator, Republican Al D’Amato, by blaming the Republicans for failing to revive the Upstate economy; meanwhile, Governor Pataki criticized his opponent, New York City Council Speaker Peter Vallone, for not caring enough about Upstate New York.   In 2000, future Senator Hillary Clinton scored points by “listening” to Upstate New York while her opponent, Republican Rick Lazio, committed a “gaffe” by claiming that Upstate New York was improving.  And one of the few risks in George Pataki’s 2002 re-election campaign was potential Upstate resentment at his “unjustified” attention to New York City in the wake of a minor incident with a couple of airplanes.  In this election, Eliot Spitzer compared Upstate to Appalachia, Tom Suozzi said upstate needs jobs, and John Faso is running in the tradition of candidates who believe lazy, undeserving New York City needs to be cut off to help hard working, deserving Upstate.