To the Editor:

As Irwin M. Stelzer [“Can Giuliani Save New York?,” December 1995] notes, in the area of crime Mayor Rudolph Giuliani has done well. Although the crime rate has dropped throughout the country, a reduction in criminal activity in New York City is no mean accomplishment. For this Giuliani should be congratulated. . . . But the city of New York faces other problems, not the least of which is the provision and cost of health care, and here the mayor has not done so well. . . .

Not long ago, the mayor set up an advisory panel which called for the city to get out of the health-care business and recommended that it dismantle its extensive municipal-hospital system either by closing hospitals or privatizing them. . . .

New York City is a perfect example of the fact that problems which end up in the health-care system and are paid for with health-care dollars originate in such social pathologies as the breakdown of the family, chronic unemployment, and violence. . . . AIDS, drug-abuse-related illnesses, . . . out-of-wedlock teenage pregnancies resulting in premature sick babies, and gunshot wounds and other crime-related injuries require intensive and expensive health care. But there is no evidence that the private sector is prepared to assume the high costs associated with these conditions. Nor does it seem likely that the elderly and the poor would be well-served, either. In fact, if the recommendations of the mayor’s commission were to be carried out, the health of all New Yorkers would be adversely affected.

Another reason why New York should not close its hospitals is self-interest. They are New York’s first line of defense against imported contagious diseases. Lassa, Marburg, and Ebola viruses, and other emerging agents that may cause hemorrhagic fevers are just an airplane trip away. . . . By dismantling the public-hospital system the city might find itself vulnerable, as the New York Times‘s Nicholas Wade puts it, “to an unrelenting stream of new or newly awakened disease organisms” which have emerged in recent years. Again, no evidence exists that the private sector will take over either the patient care or the research that the city now carries out.

Moreover, the national debate over health-care reform is by no means over. But one point remains clear: if enacted, universal health insurance will mean more not less demand for public-hospital beds. Unless we intend to ration health care, the over 40-million Americans who are now uninsured or underinsured will more than fill now-unused hospital beds. In this connection, the AIDS epidemic is a grim reminder of the need for reserve-bed capacity: 20 percent of the city’s hospital beds are now filled with AIDS patients, and the number is increasing. Thus, it is premature at the least to close our public hospitals before any health-care reform takes place. . . .

Finally, apart from functioning as a health-care resource, hospitals serve the community, especially the inner cities, as a social resource, providing jobs and education while caring for the homeless, poor, and elderly. If New York’s public hospitals were closed, thousands of workers would be laid off . . . and would then in all likelihood have to go on welfare. . . .

Leroy L. Schwartz, M.D.
Health Policy International
Princeton, New Jersey

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To the Editor:

I was surprised to read in Irwin M. Stelzer’s article that, according to Mayor Giuliani, “There is absolutely no correlation between unemployment and crime. Go look at the Depression. It was one of the safest periods in the history of this country.”

But there was a correlation: the Depression was not one of the safest periods in U.S. history.

According to the Annual Statistical Abstracts of the U.S., from 1931 to 1934 homicides hit what was then an all-time peak: over 9 per 100,000. From 1953 to 1963 homicides declined to a low of under 5 per 100,000 before going on to a new high of 10.7 in 1980, a rise that is usually attributed to drug wars. (For the reliability of homicide statistics as indicators of violence generally, . . . see Rethinking Social Policy by Christopher Jencks.)

Unemployment, too, was at an all-time high in the Depression: from 1931 to 1935 over 20 percent of the population was unemployed, a figure unequaled before or since in the U.S. . . .

William H. Mills
Olympia, Washington