Category Archives: health care spending

The DeBlasio and Cuomo Administrations: A Review

A public chief executive has three jobs: policy, management, and leadership. With leadership being using one’s influence as a public figure, in competition with celebrities and marketing influencers, to change what people voluntarily do on their own, rather than what the government forces them to do or does for them.  For state and local government, the key policy is the budget — who is made to pay how much, and what it is spent on, compared with the past and compared with other places.  Management determines how much in services and benefits people actually get for that spending.

Mayor Bill DeBlasio and Governor Andrew Cuomo spent much of their tenures feuding.  They would have you believe it was over policy and ideological differences.  I believe their primary ideology is careerism, the advancement of their own careers to higher office, and this made them rivals — and the rest of us and our futures pawns.  Perhaps that’s why both “President” DeBlasio and “President” Cuomo left office widely despised.  

But what did they actually do?  Even as we just had an election for Mayor, and are currently having an election for Governor, the media doesn’t seem to be talking about it, other than issues of the moment such as bail reform.

Most people can’t do it, but one ought to separate what the pols do from the broader situation. DeBlasio and Cuomo didn’t cause the opioid epidemic, the surge in homelessness, or the COVID-19 pandemic, or in Cuomo’s case, the long-term economic decline of Upstate New York.  But they didn’t cause the economic boom and soaring federal debt that allowed them to pander to every special interest group without completely screwing anyone else except transit riders and the later-born (until the future) either.  With regard to the budget, I’ve created some charts that make a fair and perhaps telling comparison.  This post will briefly describe what I plan to do, with additional posts making the comparisons to follow.

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Home Health Care and Local Government — A Growing Burden on NYC’s Serfs

Not long ago, I read about therapists getting arrested for stealing from programs for developmentally disadvantaged children, overbilling and not providing the services for which they had been paid.

https://www.audacy.com/1010wins/news/local/9-nyc-therapists-stole-usd3-3m-from-child-development-program

While I can’t find it now, I distinctly remember one of the articles saying that the crew had paused their scheme for a while in 2014, after another group had been caught doing the same thing.  Were the federal authorities really going to do something about this?  (They don’t have to worry about the state authorities, as NY state politicians are pro-fraud at the expense of the serfs, in exchange for political support).  After a year or two, the scammers decided the answer was no and resumed their criminal activities.

Meanwhile, the federal government was also investigating home health agencies for defrauding Medicaid.  The investigation took place in 2020, and ended late that year.

https://www.justice.gov/usao-sdny/pr/10-defendants-arrested-home-health-aide-fraud-scheme

“Money that’s earmarked for Medicaid-approved services, and fraudulently paid out to those who don’t render these services, is a crime that’s ultimately paid for by taxpayers themselves. In this case, as we allege, there were even patients involved in the kickback scheme who were willing to play along with the no-show scam in order to earn a few extra bucks. With a nearly $5 billion increase in managed long-term care plan spending recorded over a recent six-year period, the money paid out to those charged today is no drop in the bucket.”

So, was there a pause in New York City’s stunning home health care boom?  And did that pause subsequently end?

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Medicaid by State and Age Group in FY 2019:  Curiouser and Curiouser

The Centers for Medicare and Medicaid no longer provides state-level data on Medicaid expenditures and beneficiaries by age group, but it does provide state-level data on enrollment, expenditures, and expenditure per enrollee by “basis of eligibility.”  Spending per enrollee isn’t as good as spending per beneficiary in analyzing how much is being charged by the health care industry, because expenditure per enrollee is affected by the number of people enrolled who do not currently require expensive care.  And basis of eligibility is not as good as more detailed age groups, but it at least does provide separate data for children (under 18), non-disabled adults (18 to 64), seniors (65 and over), and disabled adults and children.  

When I looked at the per enrollee New York State data for FY 2019, however, I found it was reported to be far below the level of 2018, and even below the U.S. average for children and non-disabled adults.

Why?

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Medicaid By State in 2020:  At Least Some of the Data Is Back

I once wrote a post on how New York’s Medicaid spending, by age and by type of service, compared with the national average and nearby states, every couple of years.  The “State Datamart” that allowed crosstabulations of the number of Medicaid beneficiaries and expenditures, by age and by type of service, disappeared after FY 2012, after fewer and fewer states had been included for several years.  That data had allowed expenditures per beneficiary, by age group and by service type, to be calculated for each state, and the number of beneficiaries in each age group to be compared with the total population in that age group, and the population in poverty in that age group, by state.

Today there is a different set of data that has been posted, and I plan to tabulate what is available and write a couple of posts.  The PDF report is here.

And the data is at http.//macpac.gov/macstats.

It isn’t what I was once able to get, but it is more than I’ve been able to find for many years.  A quick comparison of total Medicaid expenditures in 2020, as a percent of the personal income of residents of each state, and what it cost those residents in state and local taxes, follows.

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“Affordable” Phonies Make Life Unaffordable for the Serfs

According to Merriam Webster online, affordable means able to be afforded: having a cost that is not too high.  And among New York’s Democrats and progressives there is always talk of having government policies make something affordable:  affordable education, affordable health care, affordable housing, affordable transportation, etc.  And yet observing 40 years of public policy in New York, I can think of only a handful of examples of policies that have actually made life, or a better life, less costly for the public at large.

When one examines the totality of public policies enacted in so-called Blue States, you see that the goal actually seems to be to make many things more expensive.  

Sometimes for reasons I agree with.  A developed country (and I’m not sure ours is) shouldn’t be making goods and services more affordable in the short run by making them more expensive, more dangerous, or more misery-inducing for the community as a whole, in the long run.  That’s what the builders of the “affordable” Surfside condo in Florida did by cheaping out on the building structure.

https://www.wsj.com/articles/behind-the-florida-condo-collapse-rampant-corner-cutting-11629816205?mod=trending_now_news_1

But mostly for reasons that would be impossible to justify if openly admitted.  To make some workers — those who work for the government, or are paid funded by government programs — richer compared other similar workers, at the expense of making those other similar workers pay more and become poorer.  And to make it more expensive to live in politically influential “liberal” communities, ensuring the less well off, their burdens and troubles, will be somewhere else.  The result is hypocrisy.

When Democrats and progressives say “affordable” what they really mean is “subsidized.”  Part of the cost is paid for by someone else, so it seems to be more affordable.  But since fiscal resources are not unlimited, even in New York City where we have the highest state and local tax burden and the most debt, the subsidies for “affordable” health care, education, transportation, housing etc. only end up going to the fortune few.  And many if not most of those few often turn out to be among those were already fortunate.  For the rest, somebody has to pay after all.  Often those who are already burdened by policies to make things more expensive – policies that lead to the need for subsidies to begin with.

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Current Employment Survey Data for 2020: New York City Reduced our Public Services, but Annual Average Local Government Employment Barely Fell – while the Home Health Care Boom Stalled

As noted in my prior post, the release of rebenchmarked annual average Current Employment Survey data from the Bureau of Labor Statistics shows that NYC lost the staggering total of 517,500 private wage and salary jobs from 2019 to 2020, by far the most since at least 1950 and probably the most ever.   On a percentage basis only Hawaii fared worse among U.S. areas of significant size.

More recent data is even worse.  The monthly e-mail from the New York State Department of Labor shows a decrease of 626,800 private sector wage and salary jobs (15.3%) in NYC from February 2020, before the shutdowns, to February 2021.

The annual average data shows that while the sectors that were shut down suffered the steepest job losses, there were significant decreases across all sectors – even health care.  And yet annual average New York City local government employment was just 1,400 (0.3%) lower in 2020 than it had been in 2019.  For state and local government combined the decrease was just 1,600 (0.3%).

Measured from February 2020 to February 2021, the NYC local government employment is down just 4,200 (0.8%), with a decrease of just 600 (0.4%) for elementary and secondary schools – despite falling enrollment.  And Mayor DeBlasio has cut deals with the unions to guarantee no layoffs until half a year into the next Mayor’s term, regardless of circumstances or consequences.

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Universal Health Care: What the United States Somehow Can’t Afford Even Though We Have Already Paid For It, and Then Some

I recently came across this data from the OECD, on comparative health expenditures by country as a percent of GDP.

The data by financing scheme divides health expenditures into two categories: government/compulsory and voluntary/out of pocket.  The data shows that in the United States, the compulsory/government expenditures alone equaled 14.2% of GDP.  That compares with total health care expenditures at 10.8% of GDP in Canada, 12.1% in Switzerland, 11.7% in Germany, 11.2% in France, 10.3% in the UK, 11.1% in Japan and 10.9% in Sweden.  Those developed countries all have some kind of universal health care, albeit in widely differing systems.  And all have aging populations, many to a greater extent than the U.S. 

And yet we are told by so-called Republicans/conservatives that we can’t afford the added taxpayer cost of “socialist” universal health care, and by so-called Democrats/progressives that we would need to pay even more in taxes to get it – or even to just keep what we already have.  Why?  Not because of ideology.  Because both parties are in the pockets of special interests who benefit from this situation as it is.  Both parties includes, by the way, the Democrats.

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