The Rising Public Health Leviathan: New York Leads the Nation in Transformative Health Care Restructuring

What does it mean to create a centralized government public health information infrastructure when public health includes just about everything?

You wouldn’t know it by watching the news, but the state of New York is in the midst of a major overhaul of its health care system. Part infrastructure renovation and part policy rollout, it lays the foundation for a wholesale change in the way health care is delivered, paid for, and—most importantly—defined.

This change will be transformative because it does two things at once: It expands the scope of health care to include just about every aspect of human life, and it creates a centralized database for everyone’s health information that is accessible to the government.

If you’re worried about authoritarian rules trickling down from the impending WHO Pandemic Agreement or amendments to the International Health Regulations, if you feel our government overreached just a bit during the recent pandemic, or if you simply think large-scale government projects should receive public scrutiny, take a moment with me to look at the major changes being made right now, right here at home.

These changes won’t just affect you in some potential future state of emergency. They will shape your everyday interactions with the health care system—and probably the government in general—for the foreseeable future.

Not to sound too negative! The health care overhaul is sure to usher in some positive changes and take on long-standing problems that we would all like to see tackled. It aims to improve the health of our unhealthiest populations, reduce medical errors, and implement a more holistic approach to supporting human health.

It promises a more efficient, effective, and accountable health care system, with a restructuring of our health care system’s architecture that has been in the works for decades. New York is one of the states leading the nation in this effort, at the forefront of a national and, yes, global overhaul.

But as with any major infrastructure development—whether it’s a highway system or the Internet or the iPhone’s software platform—the groundwork being laid now will make possible a whole new ecosystem. And it won’t just provide medical care.

Fundamental infrastructure changes have far-reaching consequences, both good and bad. The time to think carefully about transformative new systems is when they’re being built.

Unfortunately in this case, the general public isn’t thinking much about the public health overhaul at all. That’s because for the most part the changes aren’t being made in the public eye. The new public health leviathan is being built in boring regulatory committee meetings and opaque technical projects.

Even more visible elements of the transformation, like state legislation and budget items, go unreported by the mainstream press. Remember all the news coverage of New York’s “groundbreaking” new 1115 Medicaid waiver amendment? Yeah, me neither.

But now is the time for the public to pay attention. With federal-state deals already done, billions of dollars allocated, and new regulatory amendments drafted, the window for public engagement is closing fast. The public comment period for the state’s health data infrastructure overhaul ends in mid-April.

In the series of articles to follow, I’ll be taking a close look at the blueprints for the public health leviathan that’s being built right now in New York. I hope you’ll stick with me so that you can form your own opinion about the tech, the policies, and all the new possibilities this overhaul will open up.

The new system is being built with your money, to handle your personal information, and to manage your health and lots of other things about your life. You should be in the loop.

Part 1: New York’s Shiny New SHIN-NY

Pro tip: To save yourself from an attack of TLDR, you can use Substack’s automatic text-to-speech reader to listen to articles. It’s available in the Substack app for smartphones. Open an article in the app and look for the play icon at the top of the screen.