Two aging Manhattan hospitals need renovations to deliver modern medical care. Which hospital should get a makeover and expansion? Which should close? Astoundingly, our de-regulated health care marketplace is delivering the wrong answers:
- Lenox Hill Hospital, which charges high prices and serves an overwhelmingly white, middle- and upper-class Upper East Side community that has four other hospitals, is asking city officials for massive zoning changes to allow a $2 billion-plus expansion project.
- Beth Israel Medical Center, which charges lower prices and is the historic community hospital for the diverse Lower East Side, where many people are older, have disabilities, and are more likely to be low-income and/or people of color, is slated to close on March 26.
The stark contrast between these two situations exemplifies the chaos left by the Pataki administration’s moves to deregulate hospital prices and health care planning 25 years ago. That deregulation has resulted in a wave of hospital closures, maldistributed hospital beds and skyrocketing hospital prices.
Take the example of Beth Israel, which would become the 54th hospital to close in New York State since 1997. The closure would continue a pattern of more frequent closures in communities of color, as revealed by a new Community Service Society of New York study.
It didn’t have to be this way. Beth Israel was acquired by Mount Sinai in 2013, which proceeded to turn its break-even financial picture into a decade of financial losses. Mount Sinai stripped vital community services (maternity, pediatrics, cardiac surgery) from Beth Israel, redirecting patients to other Mount Sinai facilities uptown. A community coalition has fought the proposed closure for more than a year through the state regulatory process and the courts.
Meanwhile, Long Island-based Northwell’s proposed expansion of its Lenox Hill Hospital exemplifies all that is wrong with our de-regulated health care marketplace. It ignores parts of our city that lack adequate hospital capacity in order to build a giant new medical tower in a neighborhood that already has more than four times the citywide rate of beds per 1,000 residents.
Further, Lenox Hill Hospital already has more beds than it can fill. Last week, 43% of its beds were vacant, compared to 18% at Mount Sinai and 11% at NYU. Harlem Hospital had a vacancy rate of just 2% and Northwell’s own Queens-based Long Island Jewish Medical Center had 4%.
Our state and city can do better to allocate hospital beds wisely, by properly regulating hospital closures and expansions. The proposed Local Input for Community Healthcare Act (S1226/A6004), would require a truly public process in which the community and policymakers are informed about a potential closure and have the opportunity to have their concerns addressed. It passed the state Legislature last year but was vetoed by Gov. Hochul.
In situations like the proposed Beth Israel closure, community residents would be notified and engaged in a process that would thoughtfully consider whether patients could actually obtain needed care at alternative locations, and how equity concerns would be addressed.
For ill-considered hospital expansions in over-bedded communities like the Upper East Side, the state should follow the path of California and set up an independent Office of Health Care Affordability. It would review mergers, acquisitions and expansions to ensure that proposals like Northwell’s Lenox Hill expansion would serve a public need without increasing prices.
For now, we are left to rely on the city’s Uniform Land Use Review Process (ULURP) — conducted by officials with little health care expertise — to consider Northwell’s requested zoning changes. New Yorkers will have the opportunity to speak out against the Lenox Hill plan, beginning with a public hearing before Community Board 8 on Wednesday.
New York has the second most expensive health care in the country thanks to Pataki-era deregulation of hospital pricing and planning. Lenox Hill Hospital, for example, charges commercial health insurers more than three times what it pays Medicare for the same services, among the highest prices in Manhattan. Hospital prices are the single biggest component of our expensive New York health care costs.
It is time for policymakers to take a stand for New York’s patients and enact comprehensive and systemic pricing and planning reforms to re-regulate what is clearly a broken health care marketplace.
Jones is president and CEO of the Community Service Society of New York. Uttley is a health equity advocate and co-convenor of Community Voices for Health System Accountability.