For more than a century, the City of New York and State of New York have provided more health care and social services for city and state residents than the U.S. average, and employed more state and local government workers and paid for more workers in the non-profit sector to do it. I had always associated the shift from health and social service provision by slothful, wasteful public agencies to non-profit social service organizations with the failure of the public sector in the wake of the unionization and public pension increases of the late 1960s and early 1970s, when New York City social services became contracted out on a large scale. But reading Greater Gotham, I find the same issues and institutional battles were repeated in the early 1990s. In the (actual, original) Progressive era, the shift was from the slothful, wasteful, contracted out services provided by non-profits, religious and political organizations to “more efficient” public agencies. Basically, it seems any publicly-funded organization, whether public or private, will, in a generation or two, descend into self-dealing.
In March 2016, the City of New York employed 877 full time equivalent local government workers per 100,000 city residents in the Census Bureau’s “Public Welfare,” “Hospitals,” and “Housing and Community Development” functions combined. (I’ll take about the Public Health function in a later post, because it combines regulation and service provision). That was down from 1,023 FTEs per 100,000 in March 2006. The U.S. average was 302 local government workers, down from 309, and the Rest of New York State averaged 309, up from 296 but similar to the U.S. as a whole. New Jersey and Connecticut were lower than average at 148, down from 191, and 91, down from 103, but in these small states there is more employment in these categories at the state government level. Despite extensive local government health and social services employment, New York City’s 2016 private health care employment, at 5,715 workers per 100,000 residents, exceeded the U.S. average, at 4,737 per 100,000 residents. And NYC’s private social assistance employment, at 2,142 per 100,000 residents, nearly doubled the U.S. average of 1,108. Unlike local government employment, private, substantially government-funded employment in many industries in these sectors keeps going up.