Well, it finally came. The Commission on Health Care Facilities in the 21st Century finally finished their report on health care facilities in New York state, and it wasn't pretty. Literally, the report is almost 250 pages long. Figuratively, it's created a major firestorm in the state, including my own area of the state fairly directly.

In their own news release, they talk about how the reductions: 4,200 hospital beds, closure of 9 hospitals, 50 restructurings, and reducing nursing home beds by 3,000. This is expected to save the state around $1.5 billion dollars annually and save Medicaid around $806 million annually.

My first thought when I heard the news about the report was "Wow"! My second thought was "this isn't going to be pretty". My third thought was "this isn't going to pass". The first two thoughts have already come to pass; the third one is still to be determined. The scariest thing about this last one is that, if the state congress doesn't decide to reject the report, and instead does absolutely nothing, this goes into effect as if it had been passed; that stinks. It could let every politician in the state off the hook and allow them to later say they were totally against it, but couldn't get the political leadership of the state to consider it.

And that's unfortunate because it really does need to be addressed. A few of the closings on the report do make sense, especially the ones in the New York City area. Some of those hospitals have been in financial trouble for a long time, and there is a glut of hospitals in that area, though it's hard to say that when there are 8 million people in the area. But health care has changed, and there's more need for outpatient services than there are for inpatient beds. Many hospitals didn't keep up with that reality in the 90's, and they're paying for it now.

But some of the rest,... well, one of the small hospitals locally is on the list to be closed, but what the commission didn't take into account is that they're well placed for when the bad winter weather comes. In the winter, it really could be the determination between life and death. Another decision involves two hospitals, one actually run by the state, and they're talking about merging these two mega-hospitals, reducing the number of beds, and moving the state facility into public hands (oh yeah; New York state doesn't allow private hospitals, which is why selling them to a hospital system is out of the question). One of the best reasons for having state run teaching hospitals is that they can afford to try out new technologies and train doctors on their uses; take that away, make it a bottom line proposition only, and most hospitals aren't going to pursue them.

Yeah, I know it's a tough decision for a commission like this to put together recommendations with its main purpose being financial. The federal government went through this same thing a couple of years ago when it looked at closing VA Hospitals around the country and put some of them on the chopping block. Communities went crazy, and with good reason. The savings that either state or federal government may enjoy is a major hit on the economies of every community that has one of those hospitals, as the hospitals are usually the biggest employer in the area.

We'll know by the end of the year which direction this has gone in, but the protests have already begun.

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