A lot of this comes down to Albany and NYC just not caring. Downstate dominates the state legislature and you have to go back decades to find a Governor that isn't from the NYC-Albany-Hudson Corridor area. The state has all kinds of crazy mandates that have strangled upstate - the Medicaid burden in particular is strangling most upstate counties since NY is the only state to mandate every one of the federal governments optional Medicaid supplements AND then passes the costs on to the counties. Downstaters don't care because as long as things were good for Wall Street, things were good for NYC and as long as things were good for NYC, they were good for Albany.
In terms of the land, there's nowhere else I'd rather live... the Finger Lakes, Letchworth, a full four seasons, and the worst natural disasters tend to be snow or ice storms, which we're well equipped for. Politically and economically, the placve is a wasteland and the same solution - spend money on some grand government scheme like the Fast Ferry, Midtown or High Falls - is tried time and time again at great expense to the taxpayer. I mentioned Midtown below, for the outsiders that don't know, the taxpayers spent on the order of $80 million dollars to buy a building, tear it down and planned to give it to Paetec based on the premise that it would move a few hundred jobs a few miles from the suburbs downtown. We're blowing money to canabalize what is working here... oh, and the city never got a contract with Paetec, whom sold itself to Windstream this year anyway, and years later construction still hasn't started, so it was basically all for naught.
And that's just Rochester, look west to Erie County and the corruption is even more profound. Then we get into the hundreds (over 800 IIRC) governemnt "authorities" which are a way for the government to appoint friends to high paying political positions and waste more money off the state's books even though the government is ultimately responsible for them. All of it has caused business to flee... manufacturing used to dominate urban western NY, along with agriculture in the rural areas, and most of it has left, many for better states, not even foreign countries. Rochester's biggest employer now is the University of Rochester and while businesses flee, we seem to grow non-profit special interest organizations and healthcare jobs (just not specialists since they can make better money elsewhere) like there's no tomorrow.
And there's one other thing that keeps people here that should, under any rules of sanity, leave... their familes. That, ultimately, is why I've stayed. Lots of people, especially single people and/or young adults don't really care about moving away from their family, in fact, many of them relish it. But once you end up planting roots, it's hard to move away from the people that support you and that you support. The best thing that can happen is just admit that Upstate and Downstate have nothing in common, splitting the state into two states so that Upstate can operate free from the Downstate mandates and Downstate can stop whining about sending their tax money Upstate (yeah, lots of Upstaters think we send our money there, but the truth is it flows into here, just not at a high enough level to support the Downstate mandates).