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Another year, and another report naming New York the “Worst State for Doctors.” Time and time again, our state ranks dead last as a place for physicians to practice.
The primary reason for the Empire State’s strained relationship with the medical profession is the staggering cost of medical liability insurance. New York has the highest per capita medical liability payouts in the country. These payouts are 35 times higher, per capita, than they are in the lowest state. Nearly 20 percent of all the medical liability payouts in the U.S. are paid in New York, more than all of the medical liability payouts for the entire Midwest.
These costs drive doctors out of our state and weaken New Yorkers’ access to care. Since 2003, 16 hospitals in New York City have closed. To keep their doors open, some of the state’s remaining hospitals have opted to “go naked,” and not carry any medical liability insurance at all.
While it is tempting to blame the insurers for this cost crisis, many medical liability insurers are operating at a loss. The real culprit for New York’s runaway medical insurance costs is New York’s broken liability laws – laws that are bought and paid for by the state’s powerful trial lawyer special interest lobby.
The trial lawyer’s dominance over state government has created a disturbingly one-sided legal environment. For example, New York has no standards for expert witnesses, leading to “junk science” in the courtroom. Worse, there is no timeline for disclosure of experts, which allows personal injury lawyers to mask the merits of their case prior to trial. If doctors and their counsel do not know if the expert testifying in court is a world-class surgeon or a disbarred hack, they cannot adequately assess the evidence against them. This often leads to quick settlements, and an easy payday for plaintiffs’ lawyers.
Another boon for New York’s trial lawyers at the expense of our medical professionals is the state’s interest on judgments: the rate is currently fixed at an astonishing 9 percent. For doctors and their lawyers, running up 9 percent in interest is a major deterrent to filing an appeal. Whether cases are appealed or settled, resulting costs get passed on to patients.
New York’s spiraling medical insurance costs are not only endured by doctors and patients, they are put on the back of the taxpayer. Each year the state subsidizes the medical liability system with hundreds of millions of dollars in a desperate attempt to keep our doctors practicing here.
Many of the costs incurred by New York’s broken liability system are indirect. With the looming threat of lawsuits, many doctors practice “defensive medicine,” ordering more tests than needed. While these costs are not direct, each unnecessary procedure significantly raises the price of medical care.
But the crisis in our state’s medical liability system is not just an issue of cost and access, it is also an issue that impacts the doctor-patient relationship. New York’s current liability climate is so adversarial that physicians are dissuaded from making any statements of sympathy or apology for fear it will be used against them in court. Such statements are not only humane, but they have shown to reduce the time it takes to resolve medical liability cases. Thirty-six states have passed laws exempting statements of apology as an admission of guilt and liability. Not surprisingly, New York is not one of those states.
If the plaintiffs’ lawyers continue to get their way, lawmakers in Albany may actually make the situation worse, instead of addressing the issues discussed above. At the behest of the trial lawyers lobby, legislators are considering extending the statute of limitations on filing a medical liability claim. Enacting this proposal would undoubtedly lead to more lawsuits and even higher medical liability insurance costs. New York cannot continue to reign in last place; the Legislature needs to reject proposals that force talented medical professionals out of our state and focus on fixing the crisis at hand.
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Thomas Stebbins is executive director of the Lawsuit Reform Alliance of New York. On Twitter @ThomasStebbins and @LawsuitReformNY.
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A NYCHA board meeting
Residents understand better than anyone what it means to live in public housing. On the second anniversary of the NextGeneration NYCHA long-term strategic plan, we find our homes under attack from the federal government.
As both residents and board members of the New York City Housing Authority (NYCHA), we have unique insight into the challenges facing the housing authority, but also the successes of NextGen NYCHA. Two years ago, when Mayor de Blasio and NYCHA Chair Shola Olatoye stood in front of residents, they announced a bold plan to put us on stable financial footing. They set out a path to better fund, operate, rebuild and engage developments. And despite numerous obstacles, as residents, we can say firmly, we have made progress.
NYCHA has increased revenue by almost $33 million, saved millions and become more efficient by implementing new technology, protected buildings by building new roofs, built almost 1,500 new affordable apartments, started 10 youth councils and placed almost 6,000 residents in new jobs. NYCHA and the brave officers of the NYPD have worked together to come up with new ways to secure developments and keep our families safer. When you mention funding as well as advances in technology and job placements there is still the human element to be considered. The list could go on.
What’s important though, is that residents are starting to feel these changes and feel their voices are being heard. Their vision is being broadened, resulting in a greater sense of responsibility for their environment, and ultimately residents feeling empowered to bring about change. NYCHA is listening to residents and is genuine in their mission to change the way they do business. Everyday they’re becoming better landlords. That doesn’t mean there isn’t work left to be done - there is. But we know that with Chair Olatoye and the team she and the mayor have put in place, they are moving in the right direction and lives are improving as a result.
Despite this remarkable progress, our buildings are in poor condition because of years of neglect by the federal government. Our roofs sag, the facades are crumbling and the pipes leak. Now, the president has proposed cutting over two-thirds of the budget dedicated to keeping our buildings standing, the capital budget. This is not about politics or parties, it’s about dismantling the future of public housing and jeopardizing the progress we’ve made on our long-term plan NextGen NYCHA. It is a horrific message to send to those who are the backbone of our society. In its simplest terms, these proposed cuts would lead to higher numbers of homelessness.
We are calling firmly on our partners to stand proudly with NYCHA and demand the federal government fully fund public housing. Obstruction and budget cuts are not the road ahead for solving the housing crisis in the city. For many, NYCHA is what stands between them and homelessness. With over half a million residents, NYCHA housing is the size of Miami, and will always have room for improvement, but it is essential that we consider humanity first, before economics. If public housing isn't adequately funded, we will devastate working families, counter to the roots of public housing in our city and country. During this crisis, when the very existence of public housing is threatened, it’s time to come together to protect the lowest income New Yorkers and save NYCHA.
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The authors are Resident Board Members of the New York City Housing Authority.
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(photo: STRIVE New York)
Every Mother’s Day, across America we celebrate the women who have raised us. Cards and flowers are a fine way to mark the day. But at a time when many women face a substantial wage gap with men, struggle economically, face increasing instances of violence and, due to new government restrictions, now face the potential loss of their health care, reproductive rights, and other protections, it’s time to look at how we can make motherhood better for all mothers.
The New York Women’s Foundation has focused on the lives of women in New York City across their lifespans for the last 30 years. From this, we know that the challenges are significant, particularly for women with children. Low-income mothers often have very limited access to the basic guidance, reassurance, and resources that all mothers need to be effective nurturers and first teachers. Low-income women of color are overwhelmingly both the primary wage-earners and the primary caregivers for their families.
But the service and retail jobs overwhelmingly held by women are typically characterized by minimal pay scales, erratic hours, and total lack of any flexibility. Childcare initiatives are few, leaving it unaffordable for many, while those who work as caregivers often earn salaries that put them barely over the poverty line and sometimes they must choose between their jobs as caregivers and caring for members of their own families.
We also know that such a lack of support is consequential for children. Our most recent report focused on the youngest of girls, age 0-8. This time of life, so highly formative, sets girls on their path to womanhood and is when adult role models can have the greatest impact. Their progress is inextricably intertwined with that of the women around them and is affected by how women are treated economically and socially.
For low-income girls, however, there is an appalling lack of consistent nurturance from well-supported and well-prepared adults. Promoting little girls’ healthy development depends absolutely upon making sure that their main caregivers can give them what they need. Perhaps it should have been obvious, but we found that the best way to help girls is by helping their mothers.
Despite the historic lack of investment and resources, solutions do exist and are being pushed to the forefront. New York City has just introduced a new pilot program that will expand universal full-day pre-kindergarten to children who are three years old. “3K for All” is an ambitious idea from Mayor Bill de Blasio that could have major potential benefits, and not just for children. This program can reduce early education and childcare costs for the neediest and create new opportunities for caregivers to work. For the many women who work as early education providers, there is potential for better salaries and better access to training.
In the coming months, it behooves us to attend to the new challenges and demands facing communities as the federal funds supporting many social safety net programs and policies -- the very ones that poor women rely on the most -- are threatened with extinction.
Several things we must do:
--Support advocacy efforts promoting better workplace protections for working mothers and increased access to high-quality subsidized childcare.
--Seek out, convene, and generously fund organizations pioneering Head Start-caliber early education/parenting programs for all low-income families, regardless of whether mothers are in the workforce.
--Fund providers interested in launching/deepening services supporting mother-child healing and bonding for families living under acutely stressful circumstances.
--Strongly support nonprofit organizations working to build strong community-school-parent collaborations and supporting parents’ ability to be full educational partners.
--Seek out, convene, and fund nonprofits serving immigrant and other low-income communities, local schools, and childcare centers to create programs that support parents as first teachers and that train and place parents in volunteer positions within schools.
--Support youth development-school partnerships seeking to provide pre-K to second grade after-school services in low-income neighborhoods.
--Seek out and support community efforts improving basic overall neighborhood resources, including libraries, community gardens, farmers’ markets, and playgrounds.
Providing low-income mothers and all mother figures with a solid foundation is the most efficient way to make sure that their daughters will not face the same tough odds and the cycle of poverty that is devastating our communities. This critical support will ensure that there are more happy Mother’s Days for all women, for generations to come.
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Ana Oliveira is president & CEO of The New York Women’s Foundation. On Twitter @NYWomensFdn.
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