New York: land of medical pork

Posted: Sep 15, 2000 12:00 AM
Hillary Clinton and Rick Lazio agree on one thing: New York deserves medical pork. The two U.S. Senate candidates debated this week, both eager to highlight what the first lady called their "big differences." But on the issue of restoring public subsidies for one of the state's most powerful special interests -- teaching hospitals -- Hillary and Rick are bosom buddies. Under Medicare, the federal government covers both the direct and indirect costs of educating future medical doctors. Taxpayers funding of graduate medical education totals $7 billion a year. Roughly one-third of that goes directly to medical school teachers, classroom overhead, and residents' salaries. Teaching hospitals receive up to $100,000 per year for each resident trained, and after paying their salaries (an estimated $50,000 per resident), hospitals can pocket the rest of the federal funds. New York has more teaching hospitals -- 57 -- than any other state. Fifteen percent of the nation's doctors are trained there. The average Medicare payment for each trainee is reportedly more than four times as much at some New York hospitals as compared to teaching hospitals in other large cities. Why should the rest of the nation's workers pay for graduate medical education and residents' salaries? Hospital lobbyists argue that the subsidies help offset the costs of enhanced care. But when an independent panel set out to verify that claim, it learned that no study or survey existed that had ever quantified the cost or value of enhanced care at teaching hospitals. One health care lobbyist told Modern Healthcare magazine last fall that architects of the medical training subsidy program picked numbers "out of the sky." The doctors' lobby argues that the profession provides a vital public good that deserves federal support. Funny how this "public" good reaps such huge private rewards for M.D.s. The education subsidy is a fancy way of getting taxpayers to foot the tuition bills for supposedly impoverished graduate medical students -- who then go on to make median incomes of $170,000 a year. Other medical professionals who provide vital health care services for much lower salaries -- from emergency medical technicians and midwives to biotech researchers -- don't receive public funding for their education and post-graduate training. Both Mrs. Clinton and Rep. Lazio claim to advocate fiscal discipline. In perhaps the most laughable moment of this week's debate, the first lady declared herself a "New Democrat who supports a balanced budget." But neither she nor Rep. Lazio criticized Congress for reneging on the 1997 Balanced Budget Act and restoring $15 billion in Medicare cuts to whining teaching hospitals that couldn't survive in the marketplace without the subsidies. It's bad enough that teaching hospitals and medical schools get hefty helpings from the public trough to train doctors. But can you believe that Congress and the White House also agreed to pay teaching hospitals around the country hundreds of millions of dollars
not to train doctors? The program, also part of the 1997 Balanced Budget Act, was intended to reduce a purported glut of doctors by offering financial incentives to reduce residency slots by up to 25 percent over six years. The Balanced Budget Act earmarked $400 million in Medicare funds for New York teaching hospitals that participated in the project. Mrs. Clinton, who in her former life as health care reform czarina proposed to cut the supply of doctors and specialists by 25 percent and 50 percent respectively, now calls teaching hospitals the "crown jewels" of New York's health care system. She pledges to do all she can for the Empire State to keep the money coming. At the same time, Mrs. Clinton yammers endlessly about preserving Medicare. But she ignores the questions of why Medicare continues to funnel billions to pay for training doctors' salaries -- with no proof that it actually benefits Medicare recipients -- and at the same time, pays hospitals not to train doctors. The choice for New Yorkers is clear: a native son who has always been honest about his desire to bring home the bacon or a forked-tongued carpetbagger willing to hustle for hospital dollars in her monomaniacal quest for power.