On a recent morning, I had a first visit/consultation with a physician from Columbia-Presbyterian in New York City. In going to the city and back to Cooperstown, Columbia presents a special challenge to me.
It is a difficult facility to maneuver through under fully normal conditions and these times aren’t normal. It would have required driving about four hours each way and maybe even an overnight stay. Both the physician and I chose to do a telemedicine visit.
Most of you already know about telemedicine.
It was starting to be used by patients who had to travel long distances to see a doctor, especially if there was a satellite clinic where the transmission could be accommodated. Now, with the advent of multiple video options, the patient can be anywhere, from home to half the world away.
At the beginning of the COVID-19 lockdowns, many large practices, including hospital-based ones, decided video and telephone appointments were better than nothing. What they found out was that many times they were equal, if not better, than an in-person visit.
Probably the one thing holding back telemedicine use was the refusal of insurers, especially Medicare and Medicaid, to pay for such visits. These visits take the same, if not occasionally more, of the physician’s or mid-level provider’s time. Reimbursement, when given, was less than the equivalent amount of time for an office visit.
With the onset of COVID, insurers were forced to accept the value of telemedicine, given the lack of options if as many people were to be seen as before the pandemic. As an emergency measure, tele-visits were being approved. They still are, even when an in-person option exists.
When it comes to the COVID-19 pandemic, one thing is consistent – politicians are placing blame for the effects of the virus at the feet of other politicians, policymakers and providers, but nobody is focusing blame for the consequences of the virus where it truly belongs, with:
• The virus itself
• The state’s “hospital-centric” approach to combatting the virus and
• Historic underfunding of long-term care.
At the onset of the pandemic, the State of New York failed to immediately focus fully on the needs of nursing homes, and instead implemented a “hospital-centric” approach that led to limited access to testing, extensive staffing and PPE shortages in nursing homes.
The COVID-19 virus first appeared in the United States at a nursing home in Washington State, with devastating consequences. New York disregarded this fact and implemented a “hospital-centric” approach to combatting the virus, instead of looking at the people who were most susceptible to the COVID-19 virus – namely nursing-home residents.
New York’s “hospital-centric” approach focused the state’s limited resources on hospital-based solutions such as the Javits Center and the USS Comfort, that ultimately proved to be ill-advised, while nursing homes throughout New York State were left scrambling to safeguard their residents and staff.
Almost 80 percent of New York State’s nursing home resident care is paid for by Medicaid. The state has cut Medicaid reimbursement to nursing homes for over 12 years in a row – creating a reimbursement void that was only exacerbated by the state’s primary focus on hospitals through-out the pandemic!
The statewide average cost of providing around-the-clock nursing home care is $266. However, the statewide average Medicaid reimbursement for 24-hour care is $211, resulting in nursing homes being reimbursed $8.79 per hour to care for our most vulnerable! Most folks pay their babysitter more than $8.79 per hour!
Policymakers and legislators must stop the blame game, work in partnership with nursing home providers and view long-term care as an investment not an expense. Nursing homes are highly regulated providers that are essential in ensuring critical care to the State’s most vulnerable residents.
‘America was never that great.”
That’s an amazing quote from a man who’s had nothing but opportunity his entire life. Yes, he’s made the most of it, but that’s not the point. The point is that, because America was great, he had the opportunity to succeed.
Before moving to the point of this article, I thought it might be useful to look at the media via a historical perspective. Thus, I offer the following quote:
“Do not fear the enemy, for your enemy can only take your life. It is far better that you fear the media, for they will steal your HONOR. That awful power, the public opinion of a nation, is created in America by a horde of ignorant, self-complacent simpletons who failed at ditching and shoemaking and fetched up in journalism on their way to the poorhouse.”
Any idea who wrote it? No, not President Donald Trump. It was one of the most revered of our early writers – Mark Twain. If you’re following the path of the current nominee to the Supreme Court, it should ring true.
According to that same media, Governor Cuomo is concerned that the recent revisions to the federal tax code will unfairly cost New Yorkers $16 billion in lost deductions. Another way to interpret that concern is that the federal tax code revisions put the spotlight on the “Blue” states – states governed by Democrats – by pointing out that that we are paying too much in taxes. In our case too much is about $16 billion.
According to the governor: “We have high local property taxes and a relatively high income tax.” Is that news to any of us reading this article? About a million folks have figured this out since he became governor and left.
Each time someone leaves New York due to its high taxes, what impact does that have on those of us who remain? By definition, if we expect the same level of government “services,” our taxes must go up.
It’s interesting, the governor chose to lay part of the burden for high taxes off on the local governments by mentioning high property taxes. However, what he neglected to mention is that the county’s obligation for half of the state’s portion of Medicaid drives up local taxes.
If I remember correctly the county’s bill for Medicaid was about $11 million. That amount is roughly equal to the money collected from county tax payers. We are being forced to run county government on sales tax revenue and state aid. Our local property taxes go to pay for Medicaid. New York is the only one of the 50 states that does this.
If the government continues to give out money as “candy,” our taxes must go up even more. Some would argue that money leads to local economic growth – I would argue that we need to be certain that it does. Getting a $10 million grant and then using much of it to pay the consultants who oversee it is not a suitable return on investment.
When we read, “Oneonta just received a $250,000 grant and it didn’t cost us anything”, do we take a moment to stop and think about that?
Where does government get its money – from us in the form of taxes, fees and licenses.
This particular project may not have been funded with money from taxes collected from Oneonta residents, but a grant to some other New York community very likely was funded by tax dollars from Oneonta residents – the money all goes into the same “pool.”
However, what’s even more troubling is that a governor, who took an oath to uphold the law, has come up with a scheme to circumvent the law (an attempt to get out of that spotlight). His scheme would have enabled taxpayers to contribute to tax-deductible charitable funds set up by the various local governments which would then provide tax credits to the donors equal to 95 percent of the donations value.
As one might expect, the IRS said “no”. Beyond the scam aspect, think about the impact this could have had on the state’s charitable organizations by diverting funds that might have gone to them to local government as disguised taxes instead.
Even more troubling is the mindset that says, “If I don’t like it, I’m not going to abide by it.” Today, it’s all about “me” and how I can scam the system to improve my lot at the expense of others.
That has to change if we’re going to make America “GREAT” again. To me, what made America great was having pride in our country and being willing to work hard to make it, and thus our lives and the lives of others, better.
Mike Zagata, a former DEC commissioner in the Pataki Administration and an environmental executive for Fortune 500 companies, lives in West Davenport.