Ken Raske's response to my piece should be exhibit No. 1 in the case against the current system. When he is not using the data to obfuscate on complex matters, he displays a way of thinking that has helped create the health-care mess in New York.
To address his individual points:
* Raske accuses me of confusing financial performance with quality of care, but it is New York hospitals that persist in holding that there is no connection between the two—leading to their utter incontinence of spending. That Raske continues to argue there is no connection even while health-care experts like Solucient draw an increasingly important link between quality and financial performance only reinforces my original point that New York's hospitals still don't get it.
* Raske calls New York hospitals "efficient" by quoting a study that uses a generous cost-of-living adjustment to deflate the size of local hospital bills and that can't account for the huge subsidies being given directly to hospitals. Too bad that New Yorkers can't use this same "adjustment" to lower their real hospital bills.
* Raske's contention that other states offer more optional Medicaid benefits than New York is meaningless; New York's system spends far more than any other in the country, period. And the notion that this orgy of spending is good because it "leverages" federal dollars in New York is fiscal lunacy. While the state's cities and counties flirt with budgetary disaster because of Medicaid's burden, the federal money goes largely to hospitals.
* Raske says funding for medical education may have actually been "reduced" to a mere $544 million. But this is about three times more than any other state spends, and if you buy health insurance in New York City, the state assesses you $375 a year to finance this giveaway.
* Raske is being disingenuous about hospital capacity in New York City coming into line with some other big cities, because he knows this is only because the city's Health and Hospitals Corp. has undertaken the kind of reductions that private hospitals largely refuse to make.
* Raske may not believe that his ads were scaremongering, but another hospital executive, the head of the Iroquois Healthcare Alliance, branded them "scare tactics."
* Finally, the notion that my recommendations are "reckless" is pure Raske; he has become the Chicken Little of local health-care, forever warning that the sky will fall unless the state pumps more money into hospitals. Sooner or later, New Yorkers will catch on.