David Jones
President and CEO, Community Service Society, New York City
Summary of Presentation:
The Mindless Drive to Privatization
Presented at
Envisioning Ethical Atlernatives in Health Care
9 December 1996
Summary:
The lack of primary care physicians in poor neighborhoods, the mindless drive to privatize our city hospitals without regard to
the cost in human suffering, and the rush to push more than 1 million Medicaid recipients into managed care without education
or preparation is calamitous.
A CSS study showed that only 27 full-time physicians were available to provide care for 1.7 million New Yorkers in nine of our poorest neighborhoods. There is no evidence the situation has improved. Insufficient primary care capacity contributes to over-reliance on emergency care, often the only medical service available in many sections of this city. Plans are overwhelmed with enrollees they cannot serve. Phones, the point of entry into the system, are never answered. There are waits of weeks and in some cases months for appointments. And surely lack of community-based primary care contributes to the emerging health epidemics - like the new virulent tuberculosis strain.
Proponents of free-market solutions believe that managed care will magically expand primary care capacity. Primary care doctors are critical to making managed care work. If care is administered regularly and early, preventive medicine can do wonders. But the market argument fails because there is no carrot that can attract more doctors to underserved neighborhoods or entice the medical schools to make primary care more attractive to students.
CSS found that Medicaid beneficiaries do not understand the basic concepts of managed care and are therefore less able to adopt behaviors that allow them to benefit from the system. This lack of information can harm them. Managed care respondents - people already enrolled in programs - had no more knowledge about how managed care worked than did the fee-for-service respondents.
Services are ideologically driven. Arguments in support of bringing in the private sector to run our hospitals have more to do with a minimalist notion of how government should operate than an appreciation of how the system can best serve those for whom it was designed. The benefits of privatizing medical care are dubious.
We should require that public funds spent training doctors be used to supply the kinds of doctors needed today
We should expand efforts like the Primary Care Development Corporation
We should encourage the City and the State to monitor its own Medicaid managed care program.
The City and State should require health plans to conduct on-going member education
The City should also use its role as a purchaser of services to aggressively monitor the performance of plans holding city contracts.
Monitoring should include member education, such as the current audit the City conducts on all new enrollments