Leading by Example

Alan Jenkins

Seventy years ago this month, New York State’s political leaders gathered in Albany to confront an economic and social challenge, the Great Depression, that makes today’s situation look rosy. Representing urban, rural, and suburban communities across the state, the group assembled for a constitutional convention designed to retool the state’s constitution for the daunting challenges of a new era.

The constitution that emerged from that 1938 convention is a remarkable example of visionary leadership combined with pragmatic action and shared responsibility. It offers an important example to New York’s contemporary leaders—who are, again, meeting in Albany to address tough fiscal challenges—and to political leaders struggling with similar challenges around the country.

The Great Depression brought home foreclosures and bank failures, layoffs and homelessness, and a lack of health care and basic social services that are familiar today. Yet the breadth and depth of that crisis was vast, reaching more visibly into nearly every home, family, farm and business.

Just as important, the Depression was understood not only as a financial crisis, but as a challenge to human security and the American promise of opportunity. As then-president and former New York Governor Franklin Delano Roosevelt said in an address to Congress, , “We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence. Necessitous men are not free men….In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed. Among these are.…[t]he right to adequate medical care and the opportunity to achieve and enjoy good health.”

In the face of that challenge, New York’s leaders in 1938 enacted a state constitution that institutionalized a new social compact, particularly with regard to the most vulnerable New Yorkers, as well as health care and related public health systems.

The bipartisan convention delegates amended the constitution to create a human right to effective health care systems and to ensure basic economic security to low-income New Yorkers. A new provision declared “the protection and promotion of the health of the inhabitants of the state are matters of public concern and provision therefore shall be made by the state and by such of its subdivisions and in such manner, and by such means as the legislature shall from time to time determine.” A second provision recognized “the aid, care and support of the needy” as public concerns that the state must protect. A third provision authorized the state to provide “for the protection by insurance or otherwise, against the hazards of unemployment, sickness and old age.”

The delegates were particularly emphatic that effective health care systems are an investment in the common good and shared prosperity of the entire state. Thomas Corsi, chair of the convention’s social welfare committee, emphasized the need for state leadership to ensure “a constructive program for the promotion of positive health,” noting that “[p]oor health conditions in one locality are a menace to the State as a whole.”

Leading New York through the Great Depression required tough spending cuts, new taxes on wealthy individuals and corporations, and insisting upon cooperation and assistance from the federal government. But by also incorporating a constitutional commitment to public structures that protect basic health and economic security, the 1938 delegates were visionary as well as pragmatic.

The 1938 constitution, moreover, is not just a model. As New York’s leaders again gather in Albany, it is also a mandate. Tough decisions and fiscal discipline are clearly needed, and New York Governor David Patterson deserves credit for pressing for them. But further dismantling the state’s already frayed health care system would violate the state’s prescient constitution and must be taken off the table.

Even before the current fiscal crisis, the state had fallen out of compliance [http://www.opportunityagenda.org/site/c.mwL5KkN0LvH/b.1406015/apps/s/content.asp?ct=3269333] with its public health obligations. In 2001, for example, some 1.8 million residents lived in what the U.S. Department of Health and Human Services calls “medically underserved communities,” meaning that they have high rates of infant mortality and poverty—key community health indicators—but small numbers of primary care physicians. Nearly 3.6 million people lived in “Health Professional Shortage Areas” (areas with less than one primary care physician per 3,500 people). Between 2001 and 2005, that number increased by an estimated 13.23%.

Due to uninsurance, underinsurance, and poor healthcare planning by state agencies, nearly one in four New York City residents does not have a regular doctor, and almost 60% of New York City’s zip codes have an inadequate supply of primary care physicians willing to see Medicaid patients. More than half a million New York City residents reported needing but not receiving medical care between 2002 and 2003.

Health care services in the state are not only inadequate, but unequal. In New York City, areas with high concentrations of African Americans, Latinos, and Asian Americans are most likely to have serious shortages of primary care physicians. Hospital closures and downsizing[http://www.healthcarethatworks.org] in New York City – each with the approval of the state Department of Health – have also disproportionately harmed communities of color.

These numbers represent unnecessary suffering and death from treatable illnesses like diabetes and asthma. They also represent a shortsighted disinvestment in the economic future of the state, from lost job productivity to health care costs to the inefficient use of emergency room services.

And they are unlawful, as they fail either to “protect and promote” the health of the inhabitants of the state, or to ensure “the aid, care and support of the needy.” Whatever solutions emerge from this month’s special session in Albany must acknowledge and adhere to the social compact enacted 70 years ago under far more daunting economic circumstances.

Doing so is fully consistent with the fiscal discipline that circumstances clearly demand. Various New York leaders have proposed a range of approaches, from pursuing Medicaid and Medicare fraud by providers, to reducing and retooling corporate subsidies, to a “millionaire’s tax” to ensure that the wealthiest New Yorkers are contributing their share.

By making tough decisions while reinvesting in health care and other public structures, New York can again be a national leader at a time when that leadership is sorely needed.

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