Healthcare reform: An uphill fight

During this year's bruising budget battle, New York's scrappy new governor-former state Attorney General Eliot Spitzer-took on one of the largest and most politically entrenched healthcare systems in the nation.

Spitzer believed that that system must change because healthcare itself has. Among other things, he argued, there's less demand for long hospital stays, leading to an excess of beds and some hospitals hanging on by a shoestring. There's a growing preference among the elderly and their families for home-and community-based long-term care, leading to an excess of nursing home capacity. And there's the unnecessarily high price associated with many brand-name drugs, in an era of cheaper generic equivalents. Despite these trends, Spitzer complained, "we're left pumping billions of dollars into a broken system with no deliverables and no accountability."

As a first step toward reform, his fiscal year 2007/2008 budget included a freeze on Medicaid reimbursement rates for hospitals and nursing homes, two sectors he and his allies believed have used their political muscle to keep the money flowing, despite diminished demand for their services. Eliminating this annual cost-of-living adjustment, plus enacting other reductions in healthcare spending, would have cut $1.3 billion out of a Medicaid budget that will rise to $48.7 billion next year, by far the biggest such outlay among the states.

Never one to turn the other cheek, Spitzer fought back with several TV spots of his own, including one lampooning his critics as a bunch of crying babies.

In the end, neither side got all of what it wanted. The legislature shrunk the governor's $1.3 billion in healthcare cuts to a little more than $940 million, with hospital and nursing homes taking considerably less of a hit than he'd initially proposed.

Spitzer did score some clear victories, however. Most of his proposals for tamping down runaway Rx costs were enacted-and all of his proposals for ferreting out Medicaid fraud were. He believes that, for starters, these measures-coupled with his institutional belt tightening-will help him to expand health coverage to the state's 400,000 uninsured children. It will also enable him, he says, to pump more money into non-institutional long-term-care services, among other things.

Not all governors have Spitzer's in-your-face style-and even California's Governator has softened his hard-nosed approach since taking office in late 2003. But, if few relish a good fight as much as Spitzer does, many are nevertheless engaged in the same battles.

Doctors can help in this effort. In fact, organized medicine at the county, state, and national level needs to speak out, if only to ensure that reforms advertised as putting patients first truly do.

In New York, however, the state medical society chose to remain silent during the budget negotiations.

Whatever the politics of its decision, the state's patients deserve better in the future.