Health Care

The pandemic revealed the pros and cons of New York's health care system

New York’s hospitals proved resilient, while health care disparities remained.

The temporary hospital set up at the Javits Center in March 2020.

The temporary hospital set up at the Javits Center in March 2020. Office of Governor Andrew M. Cuomo

In the year that has passed since New York confirmed its first case, COVID-19 has taken the lives of more than 38,000 people in the state, a once-in-a-century crisis that will shape policy and public debate for years to come. In the eyes of many, the pandemic has served as a reality check, exposing deep-rooted inequities in care. But a health emergency of this magnitude has also functioned as a stress test, one that New York’s hospital system did well to withstand.

The state confirmed its first COVID-19 case – a Manhattan woman who had recently returned from Iran – on March 1, 2020. By March 24, New York City was registering more daily per capita cases than Italy, where reports of hospitals buckling amid a surge in critically ill patients rattled policymakers around the world.

Under an emergency order from the governor, hospitals across the state were already scaling up capacity. The Javits Center in Midtown Manhattan was converted into a field hospital, and the federal government dispatched a Navy hospital ship. But initial fears that the hospital infrastructure – and even its financing – might collapse under the crush of a patient influx were never borne out. At the peak of the first wave, 799 New Yorkers died on April 8, but most of the newly assembled surge capacity went unused.

The system, to be sure, came under considerable strain. At the end of March, it was reported that Elmhurst Hospital Center in Queens was operating at 125% of its capacity. But while that facility was struggling to deal with the surge in patients, not far away others had vacant beds. One of the first things that the pandemic exposed, in fact, was the atomization of the state’s health system. A more coordinated system, one operating under central management, like the National Health Service in the United Kingdom, could have served the city better at the peak of the crisis.

“You could have told people who work in upstate hospitals, ‘Please report to duty in Queens,’” said Bill Hammond, a senior fellow for health policy at the Empire Center for Public Policy. “You could have told people in Manhattan, ‘Please report to duty in Queens.’ You could have told ambulances to stop going to Queens, go to Manhattan.”

But what the system lacked in coordination it made up for in spare capacity. Before the pandemic, New York City had around 30 intensive care unit beds per 100,000 inhabitants – below the national average of 36, but much higher than peer countries like the United Kingdom (8) and France (11). Over the past year, European governments have cited overburdened ICUs as a factor in imposing lockdowns, which in many cases have lasted longer and been more stringent than those in the United States.

“If you look at England, if you look at Italy – even France, in some cases – the hospitals have just run up against capacity, and that hasn't really been such a huge crisis here,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative think tank. “In a sense, this is the flipside of our usually very high hospital costs.”

“What the system lacked in coordination it made up for in spare capacity.”

The United States spends much more on health care than any other country: $7,164 per capita, compared with $3,867 in Canada and $3,222 in the United Kingdom. While many would argue that health care in the United States is too expensive – and hospital costs inflated – that slack in the system proved to be a silver lining during the pandemic.

“It is known that single-payer systems tend to lean out the health care system to its bare minimum and there is not enough economic elasticity to deal with emergencies,” said Kenneth Raske, president of the Greater New York Hospital Association.

According to Raske, the major hospital networks in the New York metropolitan area, which are often maligned by critics of the privatized system, handled 80% of COVID-19 patients during the peak of the pandemic. They were able to do so, he said, by drawing on their financial cushion to cover additional personnel and equipment expenses.

But if the private model contributed to the ability of hospitals to flex their capacity during the pandemic, it also bears some blame for the inequitable distribution of that capability.

Over the past 20 years, more than 40 community hospitals have closed across New York state, the majority in low-income neighborhoods. Reimbursements to providers are lower for Medicaid and uninsured patients, and advocates for equity in health care blame the uneven allocation of resources – and the long-term trends towards downsizing and consolidation – on market forces taking precedence over government planning.

“If you are a hospital executive trying to make sure that your system doesn't lose money – in fact, maybe even makes some money – your incentive is to locate the beds in the places where revenues will be higher,” said Lois Uttley, the women’s health program director at Community Catalyst, a national advocacy organization.

Disparities in health care, moreover, are not limited to the distribution of ICU beds, and the ability of hospitals to rise to the challenge of a rare mass casualty event is only one measure of a system’s overall strength. Because the coronavirus poses a graver threat to those with preexisting conditions, population health is a critical factor in assessing how well a system has acquitted itself during a pandemic.

The relative dearth of investment in primary and preventative care in poor neighborhoods raises questions about the way New York’s health care system is organized, irrespective of the payment model under which it functions. “I think the pandemic proved that New York needs community doctors who know the patients, are from their neighborhoods and speak their language,” said Dr. Ramon Tallaj, chair of the board of Somos Community Care, a network of health clinics.

Barriers to primary care, which disproportionately impact communities of color, can lead to disparate health outcomes. Higher rates of chronic disease, such as obesity, hypertension and diabetes, have likely contributed to the greater toll that the pandemic has exacted on those communities.

“I think the pandemic proved that New York needs community doctors who know the patients, are from their neighborhoods and speak their language.” – Dr. Ramon Tallaj, chair of the board, Somos Community Care.

According to the Centers for Disease Control and Prevention, between March 1, 2020 and Jan. 23, 2021, the rate of hospitalization per 100,000 people for COVID-19 in the United States was 775.2 for Hispanics, 689.1 for non-Hispanic Blacks, and 239 for non-Hispanic whites.

“Let's follow the data and put resources into these areas to make care more accessible,” said C. Virginia Fields, the founder and CEO of National Black Leadership Commission on Health. “If, for example, you have a large number of people in a given zip code known to have preexisting conditions, such as diabetes, are there specialists there or do they have to go so far out of their community to see doctors?”

Fields, who served as Manhattan borough president from 1998 to 2005, said that medical facilities could be lured to underserved areas through incentives, similar to the way empowerment zones attract businesses to communities suffering from disinvestment.

Some advocates argue that the government should be more forceful in compelling networks to expand their footprint into underserved areas. “The private health systems in New York provide a lot of really excellent care, and in some cases have been among the leaders in providing care to COVID-19 patients, but we need better regulation and oversight of those systems to help encourage their investment in communities that are underserved,” Uttley said.

But large networks have been reluctant to take on the financial risk of extending into areas where the payer mix includes fewer people with commercial insurance, and consolidation in recent years has increased their leverage.

Richard Gottfried, chair of the Assembly Health Committee, told City & State it was a “constant uphill fight” getting the major hospital systems to take on more low-income patients. “We would not have to fight that fight – or certainly nowhere near as much – if the poor person’s gallbladder was worth as much as the rich person’s gallbladder,” Gottfried said. “If the plan that covers rich people also covered low-income people, then the doctors and hospitals that take care of low-income people would not need special funding.”

“Federal and state policy must provide adequate reimbursement for inner city hospitals, as well as hospitals that are in challenged communities, and it is because of the lack of adequate reimbursement that we have the problems with those institutions.” – Kenneth Raske, president, Greater New York Hospital Association.

Gottfried is known for being the Legislature’s leading proponent of the New York Health Act, which would establish a single-payer system in the state. Gov. Andrew Cuomo has opposed the bill, but Gottfried expressed optimism that a new class of progressive legislators in Albany was “going to be an enormous boost” for his cause.

New York City Council Member Carlina Rivera, who chairs the Committee on Hospitals and supports the bill, told City & State that “systemic racism and injustice” have “been allowed to fester in our state’s health care system.”

“I do think it’s New York’s responsibility to lead the way on this,” she said. “I think there are big systemic problems that will take a lot of time to fix.”

Raske, for his part, acknowledged the need to invest more resources in underserved areas, but cautioned that it would be a mistake to “throw out the good aspects of our health care system.”

“Federal and state policy must provide adequate reimbursement for inner city hospitals, as well as hospitals that are in challenged communities, and it is because of the lack of adequate reimbursement that we have the problems with those institutions,” he said.

Since U.S. Sen. Bernie Sanders built a progressive grassroots movement during the 2016 presidential campaign, support for a single-payer health system has grown on the left. Racial inequities laid bare by the pandemic, moreover, have galvanized social justice activists in New York and across the country. At the same time, appreciation for health care workers – and hospitals in general – has also risen in the country.

“Sometimes in the past, hospitals were not necessarily viewed as well as they are now – as not only a community resource, but the baseline defense for public health,” Raske said. “So, our political stock has been raised enormously, and I think all elected officials across the United States are recognizing that.”

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.