For months the health care community, especially in Cayuga County, has patiently waited to hear the findings of the New York State Commission on Health Care Facilities in the 21st Century. The Commission's sweeping recommendations are good news and bad news, depending on where you sit in the health-care hierarchy, from funder and provider to employee and patient. The commission's work now moves to the political arena for the next 30 days.

Doing any major restructuring of the status quo is never an easy task and is always fraught with political hurdles. While elected officials have the ability and power to make changes, they usually shrink from such tasks because of the political fallout of closing programs that create jobs and provide popular services. A solution to avoiding the politically hard choices about the allocation of resources and picking winners and losers, is to appoint a body of non-elected officials to make a set of recommendations and craft the group's charge to be presented for complete approval or rejection.

It was no surprise that in a state where the cost of health care is above the national average and its service delivery is rife with inefficiency that Gov. George Pataki and the Legislature went with a commission to make a set of recommendations. For nearly 18 months the commission had been reviewing both hospitals and nursing home utilization across the state. The end result is a report that will close nine hospitals of 200 plus statewide, but more significantly change the way another 48 operate.

Whether Auburn Memorial Hospital, for example, will have to close 100 beds and its Obstetrics Unit, is now in the hands of the Legislature. Pataki (and his successor, Eliot Spitzer) approved the proposals on Wednesday. The state Legislature will have only this month to accept the recommendations or reject them.

What is not clear is if there are enough votes in the Democratically controlled Assembly and Republican controlled Senate to reject the proposal? It will take both houses, not just one, to stop the plan from going into effect.

It now comes down to both vote counting and lobbying. Will enough members of the Assembly and Senate look at the recommendations and feel that the incentive of some $1.5 billion over five years from Washington in exchange for reform is worth implementing the plan, because the changes will have a minimal political impact on their own parochial political fortunes? Or are there enough members of the Assembly and Senate who figure the cost of doing this may cost them their jobs?

In the end, depending on how the head counts total, don't be surprised if the Legislature just doesn't get to a vote between now and the New Year, allowing some legislators to loudly “demand” one to give themselves political cover and still do something about the New York's costly and wasteful health-care system.

Cosentino is a former mayor of Auburn and can be e-mailed at cozguytho@aol.com