Welcome to the Capital Connection, a weekly program questioning New York State leaders on a variety of issues.
Your host is Dr. Alan Shartock, political scientist and professor emeritus at the University at Albany.
Distribution of the Capital Connection is made possible with the help of New York State United teachers,
representing professionals in education and health care, online at nysut.org.
And Nisqasa, the New York State Coalition against sexual assault, working to support men in their decisions to end sexual violence with the My Strength is Not For Herding Campaign, online at nyscas.org.
Welcome to the Capital Connection, I'm Alan Shartock. Joining us today is an old friend New York State Assemblyman Richard Gottfried, who represents the 75th district.
A Democrat, Gottfried has served in the Assembly for more than four decades. Get that. And he's still a young man. And it's the longest serving member of the Chamber.
Dick Gottfried, Assemblyman Gottfried, thanks and welcome back to the program. And how old were you when you won?
I was 23, although I looked like I was about 12 at the time.
You did, I remembered as a, as a, as a, as a, were yesterday.
And I'm just getting the hang of the job.
Now you're famous in New York State among politicians and others because you're the chairman of the very powerful Assembly Health Committee and you have been for years.
Yeah, well, you know, the health care is, I think, one of the most important issues to New Yorkers and it accounts for about a third of the state budget.
Now you've been chairman of that committee for a long time and you have made yourself the expert. If somebody wants to know about the politics of health care or health care policy, they go to you.
Other chairman come and go, but the speaker has been very good about keeping you in that spot. And in longer year there, the more your understanding of how it all works is, right?
Well, I'm blessed that the three speakers have tolerated me. And you know, health care is a, a pretty complicated field. I find it practically every day. I, I learn things that I didn't know that I didn't know.
You know, I hope my, my number of years working on the issue has, has done some good.
I was reading the paper just the other day and I was reading about the crisis of sepsis infection within hospitals. How serious is that?
Well, there's another thing that until a year or so ago, most of us who don't wear white coats didn't really know about sepsis is a severe infection in where, you know, bacteria get literally under your skin.
And if not spotted very quickly and treated can be very fatal. And apparently every year in hospitals in New York several thousand people die every year, which is, you know, 10 or 20 a day.
Fortunately, it can be dealt with and the, the state health department, the head by commissioner, Nierov Shah has just put in place a series of regulations to require hospitals to,
the monitor and, and respond more effectively to sepsis. You know, in, in the last couple of months as I visited hospitals emergency rooms, I see big signs up on, on walls and doors that say in like,
put high letters, stop sepsis and it's something that that the healthcare system is fortunately waking up to.
Dick, does it happen more often in hospitals than in the general population?
Well, I, I guess somebody who has been exposed to sepsis does tend to end up in an emergency room because they've been, I guess, injured in some way. That's how it gets under the skin.
Or they're, or they're feeling really terrible and they go to the emergency room.
And unfortunately, sometimes doctors look at and say, well, you know, go home if it gets worse, call us, but you go home if it gets worse and you very quickly die.
And so around the country, people are beginning to pay more attention to this and fortunately New York has really leapfrogged to the head of the line in dealing with it.
As I remember it, maybe my mind is getting more and more faulty, I know it is. Isn't that how McKinley died?
I think what happened is they were shot.
No, he was shot, but in order to get the bullet out, they reached into him. And I've always, it's always been my impression. It was the infection that did him in.
I think that's true, whether it technically was what was called, what we call sepsis, I don't know, but yes.
Also, apparently the fact that they were, he was one of the first people to be x-rayed, but they forgot that the springs in the bed would show up on the x-rays if the film was like on the floor.
And so they did all this x-raying and couldn't see anything.
Wow. Dick Gottfried, what's hot in the state legislature this year in healthcare other than sepsis?
Well, responding to the governor's budget, we are probably the biggest movement in the state's role in healthcare is moving more and more of the Medicaid program into some form of care management.
And that means moving more complex patients who have previously were not in managed care, but patients with behavioral health complications are now being moved in.
And then, beginning to move people who are on long term home care or, and eventually people in nursing homes into various forms of managed care, care management.
One of the things that concerns me is that there are really two ways to organize this concept. One is to put an insurance company in charge of managing your care, which is the sort of standard routine, which I don't think works out all that well in many cases.
The alternative is to put it in the hands of organizations of your healthcare providers. And whether we call it an accountable care organization or in Oregon, they're calling them community care organizations or care coordination organizations.
North Carolina has had a very good system for several years. I think provider-based care coordinating will work a lot or would work a lot better for New Yorkers. That's not yet the direction we're heading in. I'm hoping to nudge New York in that direction.
You've always been a progressive. It sounds to me like this is another one of your very good progressive ideas as opposed to the insurance companies ruling us all. But what is the likelihood of being able to nudge them?
Well, fortunately there are several states around the country that have moved their Medicaid program away from managed care companies. And I've for the last several months been trying to lobby the folks in the health department and others in this direction.
If you're right, it's not going to be easy. The executive branch has gotten used to the managed care company idea. So it's going to take some talking.
I've been quoting a lot the line that President Obama used at the National Convention back in September when he was talking about Republican plans to move more of Medicare to the insurance company side.
And he said that no American should have to spend their golden years at the mercy of insurance companies. And I keep saying why only our golden years?
Right. You are. One could ask that with Medicare too. Yeah. So, but how powerful are the New York State hospitals getting? I say that because I see that medical practices are being sold. A doctor works for himself with a couple of partners. But there seems to be a sort of centralization in which the hospitals are buying the practices. Is this a good thing?
Well, hospitals have always been certainly politically powerful in New York and have always been major powers within the health care system.
Pretty much every doctor needs to have a good relationship with his or her local hospital because every so often you've got a patient who needs to be admitted.
Yeah, but I'm talking about the buying the practices.
Well, that's, you know, as part of the, you know, the movement towards more integrated care and also part of the process of building power to negotiate more effectively with managed care companies.
A lot of hospitals are buying up medical practices so that, you know, your family doctor or those specialists you go to not only is associated with the hospital, but is an employee of the hospital.
You know, I think many doctors are concerned about that. It does have the advantage of helping to promote, you know, more integration of care and can help provide financial support to your family doctor for adopting electronic health records and things like that.
I think, I think physicians and their patients want to be trying to make sure that the hospital doesn't become like, you know, the feudal castle with the doctors and patients being served.
And so trying to build a better balance of power within those organizations is going to be pretty important.
In New York, we have in the last year or two enacted legislation authorizing things called accountable care organizations, which are essentially networks of providers.
And we put language in there to try to make sure that the control of those entities is not just dominated by hospitals, but is shared by all the healthcare providers in the organization.
And some accountable care organizations are getting organized by doctors. And so it's the organization of doctors who then go to the hospitals and say, would you like to be part of our operation?
I have a lot of questions asked you, Dick, but let's start with a tough one, which is hydrofrecking. I know that there's a health study going on by Commissioner Shaw and his department.
I know that you've been opposed to it, so we've had Commissioner Shaw and we think he's great, but I'm a little concerned that the governor will be calling the shots rather than the other way around. What do you think?
Well, in New York State government, and I've served with eight governors, governors, the governor does call the shots.
I'm concerned that what Commissioner Shaw was asked to do by the Environmental Conservation Commissioner was a lot less than we might think.
He is not, and the panel of experts he has assembled, were not asked to do a study. They were not asked to gather evidence.
They were asked to do an assessment of the data and the mitigation proposals and whatnot that the Environmental Conservation Department has put together.
The contract between the health department and their panel of experts asked them, you know, pays them for about 25 hours of work. Each of them, there are three experts.
That's not a lot, and their report is not going to come out until it sounds like days or hours before NCON announces its decision on its regulations.
So we're not going to have an opportunity to comment on the regulations after we have seen the report, because the comment period is over.
We're not going to have an opportunity much to comment on the report before the scheduled plan for putting out the regulations.
So I think New Yorkers are getting squeezed out here.
Do you think the fix is in?
Well, we don't know. It is certainly entirely possible that the administration has made a decision to go forward with fracking.
And that's the mechanism we're seeing played out here. Of course, it's also popular that they have a very different plan in mind, and maybe those of us who are concerned will be happy.
But that's a very big if.
New York State is supposed to be setting up exchanges as every other state is.
We don't do it than the feds do it for us. It looks like New York will do it.
It's very complicated for many people to understand. Can you make it simple?
It's basically a primarily online insurance store. And like going to an online place to book a hotel room or an air flight.
When the exchange is set up, if you are either an individual buying coverage or a small employer, you will go to the exchange, you will see what's available with computer organized comparisons and whatnot.
You will enter some answers to questions about yourself. If you are an individual and you're eligible for Medicaid or Family Health Plus or Child Health Plus, you will be automatically transferred to getting that coverage.
Because under the Affordable Care Act, that's what's supposed to happen. And also if you can get high quality free coverage, why would you want to pay for coverage that's going to charge you deductibles and copays.
And that's basically it.
The one good thing in the exchange as the governor is setting it up is it will not just put every product on the shelf of its store.
It will be selective as to the quality of what it puts on its shelves. And so there will be better products there.
What do you mean? In other words, they'll be making qualitative decisions as to whether this is any good.
Scope benefits, how much the individual is expected to pay in terms of deductibles and copays. There will be other standards that plans will have to comply with.
Okay, talk to me a little bit about health and guns. One of the most lethal diseases in New York are guns. We know that the legislature is just there a message of necessity, past this bill, some hunters and some others are furious. The governor's numbers have gone down by 15%. What do you make of all this?
Well, I think the legislation we passed is very good. Of course, we really need federal legislation because guns cross state lines very easily. But what we've done in New York is very good.
There are some details that need to be sorted out and we will be doing some amendments to the law in the mental health area.
I know mental health professionals are concerned that the standards there being asked to apply in terms of alerting law enforcement about a gun owner, from the mental health problems that the standards there ask to comply are not one or is not terminology they're used to using.
Yeah, in other words, somebody's in therapy and says to the therapist something about doing with themselves or doing away with somebody else. That certainly is the end of the therapeutic relationship if they're mandated to reply to the police.
That's a serious concern and it's one thing if someone is perceived to be an imminent danger to him or herself or others. It's another if the person is troubled.
I'm not certainly a mental health professional so I'm not sure exactly where is the right place to draw the lines. But I know the state medical society and the psychiatrists organization are very concerned about how they're going to be working with this.
And these are not folks who don't care about guns and violence. They're people who are concerned about how they go about helping and treating people.
And they're also concerned that it's often very hard to tell whether somebody is going to explode.
And that's partly why a lot of these weapons just don't belong in any civilian's hands. So often we read on the news that the person who went berserk, the neighbor said, oh, he was such a nice fellow. Nobody ever thought he bothered anybody and then he cracks and goes berserk.
And I suppose that can happen to almost anybody, which is why it's not good to have an assault rifle in the closet.
You're an astute politician. I want to talk. I want to get a good excuse to force. No, you are an astute politician from the very beginning. And I want to ask you this, you now have an assembly, which is real blue. What is it? Almost two thirds, Democrats.
Well, a little more.
OK, so it's basically veto proof, as we say. But in the Senate, something else is going on. You have a very interesting deal between so-called independent Democrats, some people call them traders and the Republicans, which keeping the Republicans in power.
I happen to believe, always have that Andrew Cuomo, by not vetoing the reapportion bill, as he said, he would assure that the Republicans would stay in power because they would be able to draw their own lines.
Well, that has an exactly happens. What do you make of all of this?
Well, I wish all the Democratic members in the state Senate were gathered together in a majority, sticking together.
Unfortunately, Democrats being nowhere near as disciplined or organized as Republicans tend to be. I think to have a functioning Democratic majority in the state Senate, you probably need more than a bear of 32 votes, which is a one vote majority.
You probably need 34, 35 Democrats for them to really be a functioning majority. I think in the 2014 and 2016 elections, we may well achieve that.
Because I think the way the population is shifting in New York and whatnot, I think we will get there.
I think for the time being, those of us who are not members of the state Senate have to focus on both trying to elect more Democrats in the Senate a year from now, but also seeing how we can work with this coalition to get the best results out of it.
As I say, when you've got a lemon, make lemonade, that's the hand we've been dealt whether we like it or not.
Do you fault the governor for his role in keeping the Republicans in power?
Well, except for Elliott Spitzer in his first election campaign in06, I've never known a Democratic candidate for governor or a sitting governor who was prepared to actively campaign against Republican senators.
They need them, don't they, would you like to be the bad guys?
Well, I've never been part of an executive branch, but I assume that any governor is concerned that if those guys are back in power, I'm going to have to work with them to pass my budget and other legislation.
And yeah, I think it's convenient to a governor to have a divided legislature sometimes, although Elliott Spitzer was very committed to electing a Democratic majority in the Senate, and I've always believed that that's a large part of why the Senate Republicans were so furious with him, it was because he was committed to helping elect Democrats to the state Senate and the Senate Republicans, regardless of that as an inexcusable behavior.
I couldn't agree with you more. I know that you've been a member of the Higher Education Committee, something close to my heart.
Oh, just take a minute and tell us about the state of Higher Education in New York. I went to 100, cost nothing.
Kids now have to find some real money to go, even to go to the state university or to the city university.
Do you ever see, think it will be a time when we go back to saying if we can educate a kid for free up to 12th grade, we should take the same responsibility after that?
Well, one of the first organized political thoughts that I had was back when I was about 13 or 14 years old, and understood, and I learned a lot from my parents who were both city college and hunter educated, that colleges today kind of like high school used to be, and that educating at the college level every New Yorker who was able to take advantage of that education.
Should be a public responsibility, and just like we would never think to charge tuition to go to first grade or 11th grade, we should not charge tuition to go to college in our public system.
I believe that, I believe that, fervently for 50 years.
Whether we can move back in that direction, I mean every time somebody proposes raising tuition and they say, well, you know, it's just keeping up with inflation.
My argument is, well, actually we should be reducing tuition, not raising and to keep up with inflation.
Putting that toothpaste back in the tube is going to be politically very, very difficult. Every budget is tight every year, and I think it would take a major change in public opinion, similar by the way to my goal in health care, which is to have New York at least recognize that health care should be a...
should be financed by the public on a universal basis, and that we should not be having a user charge attached to health coverage, or should be funded for every New Yorker through broad-based taxes, and it should be a universal benefit, the way the ability to send your kids to school, or to have the fire department come with your houses on fire.
Dick Gottfried, I'd love to talk to you. You're always welcome to be a guest here on the Capitol Connection. Our guest on the Capitol Connection has been New York State Assemblyman, Richard Gottfried, an old friend who has been in the Assembly for a long time. Dick Gottfried, thank you so much for being with us.
Well, it's always a pleasure, and good luck with next week's fun drive.
The Capitol Connection is distributed with the cooperation of the public radio stations of New York State. Ian Piches is producer of the Capitol Connection, a production of WAMC, Northeast Public Radio, in Albany.
Support for the Capitol Connection comes from New York State United Teachers, representing professionals in education and health care, online at nysut.org.
And Nisqasa, the New York State Coalition Against Sexual Assault, working to support men in their decisions to end sexual violence with the My Strength is Not For Herding Campaign, online at nyscasa.org.
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