City Journal Summer 2014

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Summer 2014
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Eye on the News

Bob McManus
De Blasio’s Hospital Bill Comes Due
The mayor-elect will soon have to deliver on his campaign posturing.
2 December 2013

What does Governor Cuomo have in his Santa Claus sack for Bill de Blasio? How about a full-service hospital of the mayor-elect’s very own? An empty hospital. A medically superfluous hospital. A $15-million-a-month, money-losing hospital. But a hospital, nevertheless.

There would be sublime justice in this. De Blasio, back when he was polling single digits, turned a vexing health-care conundrum—what to do with Brooklyn’s white-elephant Long Island College Hospital—into a defining campaign symbol. He contrived an arrest while demonstrating against a proposed controlled shutdown of the hospital, delighting health-care employee unions and jump-starting a flagging mayoral campaign that ended with de Blasio jiggling the keys to Gracie Mansion—and put LICH up a public-policy creek without a paddle.

De Blasio, of course, let his mouth write a lot of checks that the city fisc can’t cover—on early childhood education, in particular—but that wasn’t surprising. Long-shot candidates overreach all the time, and they usually get away with it because, after all, how often do long-shots win? But de Blasio did win, barely breaking a sweat, and now there are pledges to be redeemed.

Former mayor David Dinkins dryly (and publicly) suggested that de Blasio over-promised on pre-kindergarten education, urging the incoming mayor to lay aside his proposed millionaires’ tax and seek instead to pay for the program by reinstating a levy on commuters. But fat chance of a renewed commuter tax in 2014, a legislative election year. Better politically for de Blasio to focus on gouging millionaires—something that Cuomo has balked at, but without flatly rejecting it. The governor—who must approve an income-tax hike—has caved on top-tier taxation before. Why not now? All it should take is a little grease on the skids.

As it is, de Blasio is standing in a pre-K hole of his own digging, just as he is with LICH, a so-called community hospital located in the heart of Brownstone Brooklyn. This happens to be a “community” more than affluent enough to obtain its health care in Manhattan, which it does often enough to create ruinous economic consequences for LICH—a 155-year-old institution that had been in economic decline for decades before being absorbed by the State University of New York’s Downstate Medical Center in 2011 as an alternative to outright shutdown.

But SUNY couldn’t stop the bleeding, either. The state health department agreed that the numbers didn’t work: LICH is losing $15 million monthly and has racked up liabilities of some $500 million since the university partnership was hatched. Enter de Blasio last June, along with intensely self-interested unions and a Brooklyn-bred judge who is forcing SUNY to keep the 500-plus-bed hospital fully staffed, though it rarely has more than a dozen in-patients. Meanwhile, the state health department says Brooklyn has some 1,000 full-service hospital beds more than it needs; two other hospitals (Interfaith in Bedford-Stuyvesant and Wyckoff Heights in Bushwick) are on the verge of fiscal collapse; and Washington is poised to slash hundreds of millions in hospital aid to the city as part of the Obamacare implementation.

And it’s all on de Blasio’s plate, a seething health-care mess that promises to be a major policy distraction for years. Talk about unintended consequences.

What can he do? What should he do?

He should take full custody of his campaign promise to maintain health-care access in Brownstone Brooklyn, with one major change: It can’t come in the form of a full-service hospital. SUNY board chairman H. Carl McCall has made it clear that he’d turn over LICH to the city’s Health & Hospitals Corp. in the blink of an eye. Strip away the politics and the union fear-mongering, and all it would take are some title transfers and certification adjustments. Then the way would be clear for a rational downsizing of LICH and a return to the original objective of a low-intensity health-care center, the sort that the neighborhood actually needs (albeit not what the unions are demanding).

It will take money, of course, but this is New York; money always can be found when politicians put their minds to it. Besides, a transfer stands to cost much less than cleaning up the mess should LICH collapse of its own weight—which it will do, shortly after the various legal cases get away from Brooklyn’s politicized judiciary and into the appellate courts.

“Our challenge is to find the means to modernize and downsize these hospitals . . . and to develop community-based, ambulatory care infrastructure as rapidly as possible,” Cuomo said last spring. That was sound policy then, and it’s sound policy now—the high-ground route, if you will. Granted, not much is accomplished on the high ground in New York, and nobody knows that better than Andrew Cuomo. But he understands that establishing linkage between LICH and de Blasio’s millionaires’ tax won’t be difficult.

So, by all means, Cuomo needs to wrap a few strings, er, ribbons around Long Island College Hospital, and slip it under the de Blasio Christmas tree. It’s not like the new mayor didn’t ask for it.

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