The health care system seems to have withstood the worst of Hurricane Sandy despite some high-profile breakdowns, including the evacuation of several New York City hospitals. But experts warn that mounting budget cuts could hamper the ability of hospitals and government agencies to respond to future disasters.

Local, state and federal government agencies coordinated with each other and health care facilities to ensure the safety net would hold together during the disaster. In the hardest-hit areas of New York and New Jersey, hospitals remain open despite power outages affecting the region.

"The health care system is pretty robust around the country. We've evidenced that here," said Jerome Hauer, commissioner of the New York state Division of Homeland Security and Emergency Services. Hauer especially praised the federal government's response to Sandy, saying the U.S. Department of Health and Human Services moved 2,100 medical personnel to New York and set up six temporary treatment sites with 1,500 beds in Brooklyn and Long Island.

It's true that the health care system experienced some notable failures during the storm. More than a dozen hospitals and other health care facilities in New York state had to be evacuated, including a handful in New York City that relocated patients during the storm, Hauer said.

New York University Langone Medical Center, Bellevue Hospital Center, Coney Island Hospital and several nursing homes all underook risky and dramatic removals of vulnerable patients in the midst of the storm, power outages and flooding.

"You try to keep as many of these facilities open as possible as long as people are not in jeopardy," Hauer said. "These are always tough decisions."

Neither NYU nor New York City Mayor Michael Bloomberg has offered any explanation for why the NYU hospital in particular wasn't evacuated before the storm hit, as it was last year in advance of Hurricane Irene, or why the backup generators failed. But Jack Herrmann, chief of public health preparedness at the National Association of County and City Officials, cautioned against jumping to the conclusion that authorities made the wrong decision.

"We have to be careful about judging quickly," Herrmann said. The successful evacuation of more than 200 patients, including 20 infants from the neonatal intensive care unit, illustrates that the hospital had a contingency plan in place and carried it out, he said.

The U.S. public health infrastructure is more secure than it was at the time of the Sept. 11, 2001, terrorist assault and the following anthrax attacks, Herrmann said, because the federal government, in concert with lower levels of government, has funneled money into disaster readiness programs. "We are way better off," he said. "We invested billions of dollars in strengthening our ability to protect and respond."

The country is now seeing the "return on investment" from those initiatives to beef up hospitals and improve coordination and communication before and during major emergencies, said Herrmann.

"What you're seeing is a result of a system that has been working hard," he said. "This is why it's important to provide adequate resources."

But austerity budgeting at all levels of government threatens the gains made over the past 11 years, warned Georges Benjamin, executive director of the American Public Health Association. The public health system has been "weakened" since the recession, said Benjamin, who previously ran the health departments in Maryland and the District of Columbia. "I remain worried about the infrastructure," he added.

Last year, 40 states and the District of Columbia cut back on public health programs. Federal funding dropped an inflation-adjusted 38 percent from fiscal year 2005 to fiscal year 2012, according to a report issued in December by Trust for America's Health.

"Hospitals have done a terrific job" responding to Hurricane Sandy, Benjamin said. But that success shouldn't fool people, he added, warning that well-managed major emergencies can create a misleading sense that we are ready for anything.

"People presume that we have greater capacity than we have. When we get the big ones, we throw everything at it," Benjamin explained. "We need to make sure we have that same capacity on the shelf at all times."

Cities and states that reduced spending on public health will find themselves stretched thin when confronted with smaller-scale crises that don't prompt the federal government to get involved, according to Benjamin. "They will find themselves unable to respond to a midsize emergency," he said.

Focusing planning efforts on major disasters also takes dollars away from other important efforts, such as tracking outbreaks of infectious diseases like pertussis and West Nile virus, Benjamin said.

Hauer, the New York commissioner, is more worried about much bigger disasters, such as a major earthquake or a terrorist attack using an improvised nuclear device, that would cause more than 100,000 casualties. Health care facilities in most locales can't handle that many sick and injured people, he said.

"We are not doing very well in our ability to surge to thousands of patients," said Hauer, who previously ran New York City's emergency response agency and joined the U.S. Department of Health and Human Services following Sept. 11. New York City's vast health care system is better prepared than that of most other places, where hospitals only have "surge capacity" for patients in the hundreds, he said.

The recent string of disastrous weather events like Hurricanes Katrina, Rita, Irene and Sandy also suggest the health care system will continue to be tested, Benjamin said.

"We learned an awful lot from Katrina and Rita," he said. But he added, "Having said that, we're seeing more of these extreme storms. We're going to have to do this more often."

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The Huffington Post is eager for insights from our community, especially people with experience in power, infrastructure and engineering, on the adequacy of emergency preparation in advance of Hurricane Sandy, and the degree to which past disasters have informed adequate planning and construction. Please send a note to sandytips@huffingtonpost.com with insights and suggestions for the important questions that need to be asked of relevant private sector and government officials, and point us toward stories that need to be pursued.

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  • Kim Johnson looks over the destruction near her seaside apartment in Atlantic City, N.J., Tuesday, Oct. 30, 2012. Sandy, the storm that made landfall Monday, caused multiple fatalities, halted mass transit and cut power to more than 6 million homes and businesses. (AP Photo/Seth Wenig)

  • A videographer shoots a house in Toronto on Tuesday Oct. 30, 2012 that was crushed by a tree felled in superstorm Sandy. (AP Photo/The Canadian Press, Frank Gunn)

  • Homes damaged by a fire at Breezy Point are shown, in the New York City borough of Queens Tuesday, Oct. 30, 2012, in New York. The fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. More than 190 firefighters have contained the six-alarm blaze fire, but they are still putting out some pockets of fire. (AP Photo/Frank Franklin II)

  • Utility crews work on damaged power lines in the aftermath of superstorm Sandy in Berlin, Md. on Tuesday, Oct. 30, 2012. (AP Photo/Alex Brandon)

  • A vehicle travels a freshly plowed road Tuesday, Oct. 30, 2012, after superstorm Sandy moved through Elkins, W.Va. Sandy buried parts of West Virginia under more than a foot of snow on Tuesday, cutting power to at least 243,000 customers and closing dozens of roads. At least one death was reported. (AP Photo/Vicki Smith)

  • A fire truck passes a tree that has fallen across parked cars in the Brooklyn borough of New York the morning after superstorm Sandy struck, Tuesday, Oct. 30, 2012. A record storm surge that was higher than predicted along with high winds damaged the electrical system and plunged millions of people into darkness. Utilities say it could be up to a week before power is fully restored. (AP Photo/Mark Lennihan)

  • Halloween decorations are seen during a snowstorm, Tuesday, Oct. 30, 2012, in Elkins, W.Va. Superstorm Sandy buried parts of West Virginia under more than a foot of snow on Tuesday, cutting power to at least 243,000 customers and closing dozens of roads. At least one death was reported. (AP Photo/Vicki Smith)

  • With the Capitol in the background, a jogger passes a fallen large oak tree on the National Mall near the Smithsonian in Washington, Tuesday, Oct. 30, that was felled as Hurricane Sandy passed through Washington. (AP Photo/J. Scott Applewhite)

  • People wrap their bags while displays announcing departure times and advice about U.S. weather conditions are seen, at Madrid Barajas T4 international airport in Madrid, Tuesday, Oct. 30, 2012. Spain’s National Airport Authority said a total of 19 flights between Madrid and Barcelona and the U.S. east coast were canceled Tuesday, adding to the 13 canceled on Monday. Portugal's state-owned Lusa news agency said TAP Portugal airline canceled its daily Lisbon-Newark flight both days while United Airlines also canceled its daily flight to Portugal. (AP Photo/Daniel Ochoa de Olza)

  • Snow covers the streets Tuesday, Oct. 30, 2012, after superstorm Sandy moved through Elkins, W.Va. Sandy buried parts of West Virginia under more than a foot of snow on Tuesday, cutting power to at least 243,000 customers and closing dozens of roads. At least one death was reported. (AP Photo/Vicki Smith)

  • Utility crews work on damaged power lines in the aftermath of superstorm Sandy in Berlin, Md. on Tuesday, Oct. 30, 2012. (AP Photo/Alex Brandon)

  • Crews work to clean up downed power lines in the aftermath of superstorm Sandy, Tuesday, Oct. 30, 2012 in Milton, N.H. Thousands of New Hampshire residents and businesses were without power. (AP Photo/Jim Cole)

  • Nick Macero Jr.

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  • Using garbage bags to keep her waist dry, Mary Ann Tobias, and Walter Chaney of Moonachie, N.J. walk from their flooded home in the Metropolitan Trailer Park in Moonachie, N.J. Tuesday, Oct. 30, 2012 in the wake of superstorm Sandy. (AP Photo/Craig Ruttle)

  • Kathy Jones

    Kathy Jones calls to let her family know she's ok after damage caused by flooding destroyed her home at Breezy Point in the New York City borough of Queens, Tuesday, Oct. 30, 2012, in New York. A fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. More than 190 firefighters have contained the six-alarm blaze fire, but they are still putting out some pockets of fire. (AP Photo/Frank Franklin II)

  • Residents assess damage caused by a fire at Breezy Point, in the New York City borough of Queens Tuesday, Oct. 30, 2012, in New York. The fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. More than 190 firefighters have contained the six-alarm blaze fire, but they are still putting out some pockets of fire. (AP Photo/Frank Franklin II)

  • Waves driven by superstorm Sandy crash on the beach of Lake Ontario in Toronto on Tuesday morning, Oct. 30, 2012. (AP Photo/The Canadian Press, Frank Gunn)

  • Andrea Grolon walks through waist-deep water in the Metropolitan Trailer Park in Moonachie, N.J. on Tuesday, Oct. 30, 2012. Grolon, a resident of the trailer park, was wading through oil covered water to help others get to rescue vehicles in the wake of superstorm Sandy. (AP Photo/Craig Ruttle

  • Trees lie fallen across parked cars in the Brooklyn borough of New York the morning after superstorm Sandy made landfall, Tuesday, Oct. 30, 2012. A record storm surge that was higher than predicted along with high winds damaged the electrical system and plunged millions of people into darkness. Utilities say it could be up to a week before power is fully restored. (AP Photo/Mark Lennihan)

  • Officials assess the damage caused by a fire at Breezy Point in the New York City borough of Queens, Tuesday, Oct. 30, 2012, in New York. The fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. More than 190 firefighters have contained the six-alarm blaze fire, but they are still putting out some pockets of fire. (AP Photo/Frank Franklin II)

  • Wreckage lies outsice damaged beach front homes after superstorm Sandy in Milford, Conn., Tuesday, Oct. 30, 2012. (AP Photo/Jessica Hill)

  • A landscape of destroyed homes is at Breezy Point, in the New York City borough of Queens Tuesday, Oct. 30, 2012 in the aftermath of superstorm Sandy. The fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. More than 190 firefighters have contained the six-alarm blaze fire, but they are still putting out some pockets of fire. (AP Photo/Frank Franklin II)

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  • Firefighters work at the scene of a house fire in the aftermath of superstorm Sandy, Tuesday, Oct. 30, 2012, in Lindenhurst, N.Y. According to firefighters at the scene, four homes were destroyed by fire overnight in Lindenhurst, and six in Massapequa. (AP Photo/Jason DeCrow)

  • A member of the Moonachie Department of Public Works talks to a resident at the Metropolitan Trailer Park in Moonachie, N.J., Tuesday, Oct. 30, 2012. The park was flooded in the wake of superstorm Sandy. (AP Photo/Craig Ruttle)

  • Residents assess damage caused by a fire at Breezy Point, in the New York City borough of Queens Tuesday, Oct. 30, 2012, in New York. The fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. More than 190 firefighters have contained the six-alarm blaze fire, but they are still putting out some pockets of fire. (AP Photo/Frank Franklin II)

  • A fallen tree rests beside a parked car on East Broadway in Manhattan's Lower East Side neighborhood, Tuesday, Oct. 30, 2012, in New York. New York City awakened Tuesday to a flooded subway system, shuttered financial markets and hundreds of thousands of people without power a day after a wall of seawater and high winds slammed into the city, destroying buildings and flooding tunnels. (AP Photo/ John Minchillo)

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  • Lumber rests on a street below the Manhattan Bridge after being washed inland by flood waters superstorm Sandy, Tuesday, Oct. 30, 2012, in New York. New York City awakened Tuesday to a flooded subway system, shuttered financial markets and hundreds of thousands of people without power a day after a wall of seawater and high winds slammed into the city, destroying buildings and flooding tunnels. (AP Photo/ John Minchillo)

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  • Andrea Grolon walks through waist-deep water in the Metropolitan Trailer Park in Moonachie, N.J. on Tuesday, Oct. 30, 2012. Grolon, a resident of the trailer park, was wading through oil covered water to help others get to rescue vehicles in the wake of superstorm Sandy. (AP Photo/Craig Ruttle

  • Damage caused by a fire at Breezy Point is shown Tuesday, Oct. 30, 2012, in the aftermath of superstorm Sandy, in the New York City borough of Queens. The fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. (AP Photo/Frank Franklin II)

  • A man photographs a home damaged during a storm at Breezy Point in the New York City borough of Queens Tuesday, Oct. 30, 2012. The fire destroyed between 80 and 100 houses Monday night in an area flooded by the superstorm that began sweeping through earlier. (AP Photo/Frank Franklin II)

  • Keith Klein, right, and Eileen Blair assess the damage caused by a fire in the New York City borough of Queens, Tuesday, Oct. 30, 2012. The fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. More than 190 firefighters have contained the six-alarm blaze fire, but they are still putting out some pockets of fire. (AP Photo/Frank Franklin II)

  • Keith Klein walks through homes damaged by a fire at Breezy Point in the New York City borough of Queens. Tuesday, Oct. 30, 2012. The fire destroyed between 80 and 100 houses Monday night in an area flooded by the superstorm that began sweeping through earlier. (AP Photo/Frank Franklin II)

  • A rainbow forms over Breezy Point in the New York City borough of Queens, in the aftermath of superstorm Sandy, Tuesday, Oct. 30, 2012, in New York. The fire destroyed between 80 and 100 houses Monday night in the flooded neighborhood. (AP Photo/Frank Franklin II)

  • A woman is lifted into a National Guard vehicle after leaving her flooded home at the Metropolitan Trailer Park in Moonachie, N.J. Tuesday, Oct. 30, 2012, after supsterstorm Sandy. Sandy, which was downgraded from hurricane just before making landfall, caused multiple fatalities, halted mass transit and cut power to more than 6 million homes and businesses. (AP Photo/Craig Ruttle)

  • CORRECTS NAME OF FLOODED AREA TO BATTERY PARK UNDERPASS, INSTEAD OF BROOKLYN BATTERY TUNNEL - Water reaches street level at the West Street entrance to the Battery Park Underpass, Tuesday, Oct. 30, 2012, in New York. Sandy, the storm that made landfall Monday, caused multiple fatalities, halted mass transit and cut power to more than 6 million homes and businesses. (AP Photo/ Louis Lanzano)

  • A keep off the dunes sign is buried Tuesday morning, Oct. 29, 2012, in Cape May, N.J., after a storm surge from superstormSandy pushed the Atlantic Ocean over the beach and into the streets. The storm that made landfall in New Jersey on Monday evening with 80 mph sustained winds killed at least 16 people in seven states, cut power to more than 7.4 million homes and businesses from the Carolinas to Ohio, caused scares at two nuclear power plants and stopped the presidential campaign cold. (AP Photo/Mel Evans)

  • Jorge, 30, left, and Yaw, 28, wait in front of a closed United Airlines check in area after their flights toNew York were canceled at the international airport in Barcelona, Spain, Tuesday, Oct. 30, 2012. Spain’s National Airport Authority said a total of 19 flights between Madrid and Barcelona and the U.S. east coast were canceled Tuesday, adding to the 13 canceled on Monday. Portugal's state-owned Lusa news agency said TAP Portugal airline canceled its daily Lisbon-Newark flight both days while United Airlines also canceled its daily flight to Portugal. (AP Photo/Manu Fernandez)

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