In the new year, New Yorkers will see if the hallmark promises of Mayor-elect Zohran Mamdani’s campaign can come to life. With rent freezes, free buses and free childcare promises, Mamdani won over the public by painting bold visions of a more affordable city. His proposals for healthcare, in comparison, are lackluster both in detail and ambition. New Yorkers have inequitable access to high-quality healthcare depending on where they live. His three short paragraphs on healthcare on the campaign website proposes to increase access in general through outreach workers and public hospital funding, but does not grapple with this unacceptable status quo.
New York State has previously made headlines for ranking near the bottom of the 50 states in the average quality of care of its hospitals. This is despite the state having the third-highest per capita healthcare spending nationwide, and being home to world-class hospitals–with people traveling from abroad to receive care at institutions like NYU Langone and Mount Sinai. These high-quality outliers are eclipsed by a mass of lower-performing institutions, unevenly distributed by geography. For example, Manhattan has four high-quality (4 or 5 Center for Medicare and Medicaid Services star) hospitals serving the borough, while Brooklyn has only one–limited to veterans–and Staten Island has none. Public hospitals, which are more likely to serve Medicaid and uninsured patients, perform worse than their privately-owned counterparts.
The drivers of poor hospital performance are multi-dimensional and not well understood. Some studies say that hospitals that struggle financially are more likely to provide substandard care, while others point to the challenge of serving sicker and more socioeconomically disadvantaged patients. Drivers can be internal as well, with operational inefficiencies and not following best practices contributing to the quality problem. Regardless of cause, the result demands a reckoning: New York City residents have differential access to quality care, depending on their zip code. The results are sobering. Even within our borough, for example, rates of obesity and hypertension in Brownsville are triple and double those of Fort Greene and Brooklyn Heights, respectively. Life expectancy is seven years shorter.
This phenomenon could be addressed in two ways: lowering structural barriers to patients seeking high-quality care where they exist, and increasing high-quality care in underserved zip codes. The first has the potential to be addressed in Mamdani’s vision of outreach workers who help residents navigate care affordability. However, its lack of specificity raises more questions. Who will they help? How would they make sure underinsured patients get access to timely, effective care, when some providers, such as for-profit hospitals, are not required to provide charity care or serve Medicaid patients? Roughly half of Brooklynites are on Medicaid, and risk losing coverage as the One Big Beautiful Bill Act takes effect. Health outcomes will worsen as people avoid seeking care, given the crippling sticker price without insurance.
Then, there is the issue of increasing the supply of high-quality healthcare more equitably. Mamdani’s proposal of increased blanket funding for NYC Health + Hospitals, while well-intentioned, is unlikely to produce the quality improvements we need. Moreover, preventing public and critical access hospitals from shuttering, as proposed by his campaign, would be the lowest bar to meet. What would it take for these safety-net hospitals to become attractive places to seek care?
There are more targeted approaches worth considering to build on Mamdani’s proposals. The outreach corps idea could be expanded into partnerships with community-based organizations, for example, to bring free, high-quality services closer to the residents that need them. Geographies should be targeted based on an examination of health disparities. The city could also fund targeted quality improvement initiatives based on thorough investigations at hospitals in underserved zip codes. The future of healthcare in the city merits this level of attention, as showcased in Mamdani’s other policy areas.
The mayor’s healthcare initiatives may be constrained, given much of the system is governed at the federal and state level. However, Mamdani has not shied away from bold ideas elsewhere. Inspiration and reimagination are necessary to shine a light on the problem. The next four years are an opportunity for Mamdani to bring healthcare equity to the forefront and refuse the status quo of inequitable access rampant in our city.
Ye Hyung Kim is a healthcare consultant in Brooklyn.
