Well, the queue of drafted, but incomplete posts is way too long and the (much appreciated) complaints about the absence of posts are getting to me. So we're starting up again today.
I've been working on a series of fairly lengthy posts about healthcare budget politics in New York and the feud over how we should get to a smaller sized hospital and nursing home system. Note that it's no longer whether; it's how. I'm betting that this is a very significant change in the public debate.
For decades, it's been the dirty little secret among professionals that New York is way over-bedded. But the hospital and nursing home associations couldn't really admit that in public. The first to break was NYAHSA when they began to talk about "rightsizing" a couple of years ago. But now they're all in on the action. But that also means that the issues which were repressed are bubbling to the surface:
- To what degree can, should, and will unionized facilities get favored treatment in this colossal game of Survivor? Can't we just imagine the "tribal councils" to vote hospitals off the island?
- What are the implications of the upstate/downstate differences in hospital organizational structures? (Downstate, most are part of multi-hospital systems. Upstate, they are not.)
- From a programmatic and economic perspective, which is the better approach, market or regulatory? This isn't just a question of ideology. Would the actual results from the two approaches really differ?
- Which will cause more political damage in the districts that lose facilities, an active regulatory role (you, Mr. Legislator gave the Governor and this commission the authority to close my hospital) or (you, Mr. Legislator stood by while my hospital was forced to close because the market squeezed the life out it)?
But in the meantime, there have been some Medicaid developments I'm mixed up in that are all at the same time, amusing, amazing, promising, and troubling. More on that tomorrow. Not to be a tease, but it appears that a Medicaid paper I wrote a couple years ago is now in the middle of a political brawl between State and County officials. I'm meeting this afternoon with a Senator who sent the paper to county officials all over the State. (What was that old quote about the honor of facing a firing squad?)
I've actually got most of the next post written, but probably shouldn't finish it and certainly shouldn't post it until after I've met with the Senator.
Also on the docket for tomorrow (though it may be very late tomorrow) ...
Part of the reason for my absence the past couple of weeks (yes, it's an excuse and a pretty lame one at that) has been work on a new website. Here you get to read my yammering. But except for a few bold souls, I don't get to read yours. So we've been working on something that I think will be distinctive in the the healthcare environment. Stay tuned.
And thanks for your patience.