Governor Hochul yesterday nominated Dr. James McDonald to be the state health commissioner. McDonald, who has served as acting commissioner since the beginning of the year, has his work cut out for him as he heads a department overseeing a proposed $215.6 billion in spending, including $196.4 billion in Medicaid, which underpins New York’s highest per capita health spending in the nation.
The department’s policies and programs have a direct impact on the health of 20 million New Yorkers. It licenses hospitals, regulates nursing homes, recommends infectious disease and pandemic policies to the governor, and manages insurance exchanges.
The degree to which the New York Department of Health is completely off the rails after 10 years of Andrew Cuomo and a rapidly retiring interim commissioner from Hochul, can be gauged by the fact that it does not have, and never has had, any plans to control and prevent diabetes, the state’s most widespread, costly and damaging epidemic, especially in low-income and underserved communities.
Diabetes alone accounts for a staggering 20% of Medicaid’s budget, and the state’s cost per person for a Medicaid diabetes patient is nearly double the national average. But Hochul’s budget proposal does not contain a single penny to implement well-known strategies to prevent new cases and minimize the terrible complications when people have diabetes.
A minimal investment in these preventative programs would literally save billions of tax dollars and thousands of lives.
It is up to the new commissioner to deal with health hierarchies that leave masses of people, especially Black and Latino people, much sicker than they should be.
That means challenging the state’s vast medical industry: the interlocking academic medical centers, vast hospital systems, managed care organizations, insurers and ancillary services not seen in any other state. While a commissioner does not “command” this industry, licensing and other powers allow him or her to propel it toward greater public accountability and, above all, better patient outcomes.
It would be hard to overstate the dysfunction in what is best described as a sick industry. As the mass illness of diabetes and other chronic diseases worsens, the system remains rooted in costly procedures and endless costly emergencies while ignoring preventative care and wellness.
Its own atmosphere is so harrowing that even frontline health care workers, famous for their dedication, are leaving by the thousands. They look very highly upon a system that directs billions to insurers and pharmaceutical giants, and millions to high-level administrators, while being overwhelmed by a tsunami of patients who are sicker than they should be.
Good self-control education is the vaccine for the age of chronic disease. It protects people from the worst and community groups provide it most effectively as they can make it accessible to the people who need it most. When my organization trained peer educators, most of whom were homeless, to deliver a six-session diabetes self-management course to 201 homeless shelter participantsER visits plummeted 45% and hospitalizations by 74% in six months. This alone saved an average of $1,000 to $2,000 per participant in just six months. Multiply that for the entire state.
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As the new commissioner, McDonald’s must prioritize wellness and self-care, providing a clear view of the best protocols, such as Lifestyle Medicine with its proven ability to vastly improve, and even reverse, a variety of chronic diseases.
And McDonald’s must have an equally keen eye for New York’s political shoals. He requires the governor to sustain his efforts.
Consider just one statistic.
For more than a decade, diabetes-related lower extremity amputations in New York have increased at twice the national rate. Average lifetime medical costs for these disfiguring operations are more than $500,000 (surgery, anesthesia, prosthesis, etc.) With an estimated 50,000 amputations since 2009preventive care would have saved an estimated $25 billion in lifetime medical costs for amputations, primarily from Medicaid and Medicare.
Even the conservative American Diabetes Association believes that effective early intervention can prevent 85% of diabetic amputations. Yet no commissioner has expressed a word of concern about this routine and preventable mutilation of primarily low-income New Yorkers with diabetes.
The day a commissioner orders every hospital in the state to develop a plan to prevent unnecessary amputations, known as a “limb-salvage plan,” will be the day it becomes clear that healthcare in New York is finally changing, that the state will save billions. , and patients need not fear the worst from the country’s most expensive and dysfunctional healthcare system.
Norwood is the founder and CEO of Health People, based in the Bronx.