The New York Times reported this week that New York teaching hospitals—Stony Brook Hospital included—could stand to suffer more than the national average if the cuts to Medicare programs that congressional Republicans are seeking are part of a larger series of spending cuts. President Obama has indicated that he may be willing to accept some cuts to Medicare, but many congressional Democrats have voiced strong opposition to the plan.

“While there is no formal proposal on the table, we have heard that significant cuts to Medicare medical education payments have been discussed that could have a negative impact of up to $30 million on Stony Brook University Medical Center,” said Stony Brook Hospital CEO Steven Strongwater on Friday.

That would be part of an estimated $1 billion in cuts to teaching hospitals across New York State, reported the New York Times.

A $30 million loss would be devastating to Stony Brook University Medical Center, which also saw state funding cut in half this year under Governor Cuomo’s cost-cutting budget. All told, Stony Brook University Medical Center could lose as much as $60 million this year if the federal government moves ahead with Medicare cuts.

A cut of that size, almost 7 percent of SBUMC’s overall budget, could begin to have noticeable impacts on both patient treatment and physician training, warns Strongwater.

“We feel strongly that reducing medical education payments would be extremely harmful in light of the current physician shortage and growing demand for health care under health reform and because of our aging population,” he said.

As Stony Brook University prepares for the next round of budget cuts, priced around $10 million, its medical center is facing something a little more severe—the complete withdrawal of state-aid.

Under Governor Andrew Cuomo’s most recent budget proposal, Stony Brook’s Medical Center is slated to lose all $55 million received in state-subsidies. That’s not including an additional $10 million cut from a proposed statewide $3 billion reduction of Medicaid.

“We use that money to provide the programs that nobody else provides, to support the undercompensated patients—the patients that don’t have anywhere else to turn,” said Dr. Kenneth Kaushansky, Dean of Stony Brook’s Medical School, referring to the hospital’s emergency psychiatric ward, burn center and a Level I trauma center.

Kaushanksy proudly stated that these services are the only one of its kind in all of Suffolk County and that SBUMC covers roughly $86 million spent in indigent care, or patients taken in without health insurance and do not apply for Medicare or Medicaid. It’s these facts and figures that administrative directors are presenting to their local legislators in hopes of swaying the vote.

Cuomo’s $154-million cost saving plan to cut all state-support to all of New York’s public teaching hospitals, which also includes Downstate Medical in Brooklyn and Upstate Medical in Syracuse, are in part an attempt to chip away at the state’s looming $10 billion deficit.

“‘Cut’ is not even the right word—it’s a complete elimination,” says Assemblyman Steve Englebright, a democrat who represents the Stony Brook area in the Fourth District. “To remove all state support and subsidy is a completely unreal proposal because the hospital has such obligations as to run a medical school, a dental school, a nursing program, a burn center, a cancer center—all of these are public, not private,” said the former Stony Brook Geology professor and alum.

Questions and criticism have also been raised for the role of North Shore Long Island Jewish Hospital President and CEO Michael Dowling in Cuomo’s administration. Once a healthcare advisor to former Governor Mario Cuomo, Dowling runs the same hospital chain that is heavily involved in the development of Hofstra University’s new medical school. Dowling co-chairs Cuomo’s Medicaid team.

Kaushansky declined to comment on what many view as a conflict-of-interest, but was accepting of Hofstra’s new medical school. “There’s little question that we need more doctors in the U.S. whether it’s primary care, general physicians or pediatricians,” the recently appointed Dean said. “We need more medical schools that deliver high quality care in the U.S. [and] I actually welcome them.”

In 2009, SBUMC experienced a 90 percent occupancy rate with more than 80,000 emergency visits and roughly 227,000 outpatient visits. Additionally, roughly $90 million was spent on research, mainly acquired through a variety of grants. This all took place with a staff of a little more than 5,500 employees and 1,000 physicians, half of whom are full-time. But these numbers may very soon decrease, as would the services the hospital provides.

“I don’t want to limit the patients who knock on our door for healthcare,” said Kaushanksy, who added that after years of budgetary dieting, there is little fat to be cut from the hospital budget. “Everyone in my opinion deserves the best healthcare, but if we are to remain open we are going to have to think about that.”

John Oliver in the hallways of the SBUMC with Stony Brook Prof. Stephen Post. (Screen Capture of The Daily Show, 12/8/10)

Stony Brook’s community of Daily Show fanatics (myself among them) got a real treat on last night’s show. As part of a segment about the nation’s most prominent—and perhaps only—truly civil political campaign, The Daily Show’s John Oliver interviewed one Stephen G. Post, the Director of the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University.

Oliver and a crew from the Daily Show were on campus several weeks ago to shoot the interview, which took place largely in a ninth floor research lab.

“It was an amazing experience,” said Post on Thursday morning, the day after his segment aired.

The clip that viewers saw lasted perhaps 30 seconds, but Post says that Oliver and the crew spent a great deal more time with him.

“The whole thing took about five hours,” he said. “They only picked out a brief little bit but I loved the story line.”

The segment focused on a Connecticut state senate election that got some national publicity for the civility displayed by both candidates, Democrat Andrew Maynard and Republican Stuart Norman. Oliver, in typically hilarious fashion, questioned the legitimacy of a political campaign without attack ads, and for scientific evidence turned to Dr. Stephen Post.

The segment (watch it below), involved a sit down interview, b-roll of the university medical center, and one slapstick bit involving a trust fall gone wrong. Segment begins at about the 4:00 mark.

Expensive purchases, like ambulances, are paid in large part by undergraduate students.

Your professor is in the middle of a lecture when he suddenly begins having severe chest pains and fears he is having a heart attack. Someone dials 911. An ambulance is dispatched, and within minutes, he’s on his way to the hospital. Everyone in the lecture hall probably took it for granted that a 911 call would receive this response. But whose ambulance responded, and who paid for that ambulance ride? The ambulance was likely operated by the Stony Brook Volunteer Ambulance Corps (SBVAC), and as for who paid for it, that answer may surprise you: if you’re an undergraduate student, it was financed in large part by the Student Activity Fees you and your classmates pay every semester.

The idea for this article came into my mind as some friends and I, all relatively familiar with the Undergraduate Student Government budget, were casually discussing the issue of club funding before a USG Senate meeting. We were talking about which clubs received the largest budget allocations when someone mentioned SBVAC. Founded in 1970 and staffed by fully qualified student volunteers, SBVAC is not only our primary emergency medical service but also one of the largest and oldest student organizations on campus, and one that consistently receives some of the largest budget allocations from the USG. My friend opined that SBVAC provides a vital service to the entire campus community, not just undergraduate students – after all, someone had to respond when your professor was having that possible heart attack – and that it was therefore unfair for USG to bear the burden of being the organization’s primary source of funding. USG serves not only undergraduates, but graduate students, faculty, staff, visitors and anyone else who happened to need emergency medical attention while on campus.

I’d seen the USG budget many times before, and was aware of the large size of SBVAC’s budget allocation in comparison to those of other student clubs. In 2008-2009, it was the only club that allocated more than $200,000, or around 13% of the total allocation for club budgets, which was spread over 98 clubs. But I’d never given it a second thought; after all, as my friend had pointed out, running the primary emergency medical service on a campus with a population in the tens of thousands is an important job, and one that inevitably costs a lot more money than the operations of a typical club. Perhaps I hadn’t seen the ‘forest for the trees’: sure, SBVAC deserves to be well funded, but why was it treated not as a public service but as a student club, and why were undergraduate students disproportionately responsible for it’s funding?

A bit of cursory research on the web site of the National Collegiate EMS Foundation, of which SBVAC is a member, revealed that this arrangement is not terribly uncommon, but there is a wide variety of funding arrangements for college and university EMS groups. For example, similar organizations at Binghamton University and the University at Albany are funded in the same way as SBVAC, by their respective student governments. The ambulance service at SUNY New Paltz supplements funding from the college by billing the patients it transports, unlike SBVAC, whose services are provided free of charge. Outside the SUNY system, Columbia University’s ambulance service again relies both on funding from the university and on reimbursements from patients’ health insurance; Rochester Institute of Technology’s service is funded entirely by its Student Health Center; and at Cornell University, emergency service is funded much like SBVAC, through the student government. So despite the array of funding options on display, money from student governments seems to be a very popular way of paying for what seems more like an important public safety function than an activity for students (even if the organization is made up of student volunteers, as SBVAC is).

When I spoke to SBVAC President Christine Larose about her organization’s funding, she lamented the instability inherent in the USG budget allocation process, but did not necessarily welcome a change in its funding structure. She noted the large fluctuations in the size of budget allocations from year to year, and that it has been “lately, more down than up,” but was not particularly enthusiastic about the prospect of being funded by the university.

A direct financial relationship with the university “would have its pros and its cons,” Larose explained. “It might be financially beneficial, but we would lose some of the autonomy we have now.”

Direct funding from the university, of which SBVAC currently receives none, would mean more direct control by the university’s administration and less flexibility for the organization, a situation of which Larose is understandably leery. For now it seems that SBVAC is content to sacrifice a bit of financial security for greater freedom in conducting its operations. Besides, with rampant budget cuts always looming on the horizon, university funding might barely be less volatile than that provided by the USG.

So that leaves me where I started, with the issue of fairness to those of us who, as undergraduates, are mainly responsible for funding SBVAC. For the 2009-2010 academic year, SBVAC requested a budget allocation of $182,000 from the USG. Combined with a projected $2,000 in funding from the Graduate Student Organization and $25,000 from New York State – the latter being the only funding SBVAC receives that is not directly from student fees – it projected a total income of $209,000. In this situation, undergraduates would have provided 98.9% of SBVAC’s student-provided funding, with graduate students paying just 1.1%. This, despite the fact that undergraduates make up only 76% of full-time students and 66.4% of total students at Stony Brook according to the Fall 2009 enrollment figures provided by the university. And despite the service also being used by its employees, visitors and others, the university contributes nothing at all.

Regardless, SBVAC does not appear set to receive the $182,000 it requested from the USG; while budgets are still subject to revision, its current allocation for 2009-2010 is $145,209.30. Based on Fall 2009 enrollment figures, that’s approximately $9.85 per full-time undergraduate. (Part-time students don’t pay the Student Activity Fee.) This is significantly less than the $201,000 it received in 2008-2009 (when it requested $199,410), but far more than the $98,189 it received in 2007-2008 (when it requested $131,419.20). Even with the lower contribution, if the GSO contributes the projected $2,000 (which works out to about $0.42 per full-time graduate student, or about 4.3% of what each full-time undergraduate pays), USG will be responsible for 98.6% of the student contribution to the SBVAC budget for 2009-2010 and, assuming a $25,000 contribution from New York State, 84.3% of the total.

Even at this relatively high cost, SBVAC is still clearly an asset to the Stony Brook University community. But that is the entire community, not just undergraduates; and whether the burden of funding it is distributed fairly across that community is another matter, and certainly a debatable one.

Over the last few months, the most prevalent issue in the national political discussion has been President Obama’s crusade to reform our broken health care system.  As one of the only developed industrial nations without a universal health care system, the United States ranks shockingly low on many international health rankings.  Whether one is a single parent, a small business owner, or a college student, the fight to provide suitable health care coverage is a salient issue for most Americans.

The Stony Brook University Medical Center is home to the best ideas in medicine, save for one: universal health care. At least not yet.

Fortunately, legislation has recently been proposed in Congress to remedy this problem.  Although not perfect, the proposed health care bill recently put forth by Senate Majority Leader Harry Reid (D., Nevada) would expand coverage to 94% of all Americans, and would simultaneously reduce the federal budget deficit.   Rather than fit the stereotype of an intrusive liberal program, this bill allows those Americans who are happy with their coverage to keep it as is. This bill will clearly be a boon for our federal government, for many Americans struggling to provide their families with proper health insurance, and not least of all for businesses weighed down by the overwhelming costs of providing their employees with health coverage.  Here at Think, we wonder whether these expected positive results will also translate to college campuses.

Many of the uninsured are college students or recent college graduates.  Currently, college students are usually covered by their parent’s health plans, but upon graduating they are left to fend for themselves.  The proposed health care bill would extend the aforementioned privilege to include young adults as old as twenty-six.  This would ease the burden on college graduates, who are one of the most susceptible demographics to health care problems.  Already saddled with student loans and the pressure of finding gainful employment, the news that health care will be provided for college graduates is a good sign that the Obama administration has remembered that even college graduates need assistance at times.

While it is true that many young Americans do choose not to purchase health insurance, believing themselves to be invincible, this is not as widespread a phenomenon as the opponents of universal health care would like the public to believe.  To hear conservatives tell it, the vast majority of the uninsured are arrogant young people in their twenties who distort national statistics by refusing to purchase coverage that they could easily afford.  In fact, a majority of the uninsured truly are those who cannot afford it, including a great number of college graduates who do not possess the financial means to insure themselves.  Furthermore, there are an unknown, but substantial, number of college students who are electing to intentionally delay their graduation in the hopes of remaining on their parent’s insurance.  The resulting glut of college students has had a negative effect on the college experience, most palpably felt by students who are now struggling to find housing on campus.  Many of these older students have conditions that can only be treated using the health care available to them as college students.

I recently spoke with Dr. Raymond Goldstein to discuss the Baucus health care bill and its prospective effects on college students, and on the country as a whole. The following are a summation of his thoughts on the issue, prompted by three overarching questions I asked him during my interview with him.

What effects, if any, will the proposed health care bill have on college students?

The health care bill as it stands right now will not do enough to remedy the current situation.  Rather than excise the harmful inclusion of insurance companies in our health car system, the Baucus bill will be a windfall for these same companies who have so badly harmed our nation.

In regards to college students, Dr. Goldstein’s prognosis is hardly more promising.  Although he predicts that the stipulation in the bill that young adults can remain on their parent’s coverage until the age of 26 may result in short term improvements for our demographic, he believes that this is only on the margins of our age group, and that this part of the bill will also help the companies.  The lack of regulation in the bill will allow insurance companies to charge higher premiums for the young adults remaining on their parent’s plans.

Dr. Goldstein believes that real reform would be a boon to college students, but that any bill without a strong public option included will do nothing to alleviate any current or potential suffering that we experience.  Without a public option, or at least clear regulations on predatory practices by insurance companies, this bill may exacerbate current problems in our system, rather than cure them.

Does the University Medical Center have an official position on the proposed legislation?

The University has not officially weighed in on the issue, although the individuals in the medical center obviously have their own strong opinions.  Dr. Goldstein referred to Dr. David Brown as being a strong proponent of a single payer system, although he assured me that most doctors on campus are opponents of any progressive health reform.

Are there any common myths and misconceptions about health care that you would like to dispel?

It is important to stress that Americans should look to Western European health care systems for guidance, rather than demonizing them for simply being “un-American”.   Dr. Goldstein thinks that our pervasive ideology of what he calls “rugged individualism” has harmed us in this area, and that this mode of thinking is responsible for the insurance companies being able to maximize their profits at the expense of public welfare.  In an interesting side note, he also submitted that the current state of our health care system in relation to Western Europe’s is a definite contributing factor in the continuing weakness of the US dollar compared to the Euro.