Pros, cons of single-payer health care debated
The New York State Legislature held a daylong hearing Tuesday on a proposal to enact single-payer health care in New York.
A packed room listened as supporters and opponents debated whether it’s the answer to the state’s health care gaps.
Assembly Health Committee Chair Richard Gottfried, prime sponsor of the legislation known as the New York Health Act, laid out the problem. Millions of New Yorkers have some form of health coverage, he said. But many still face financial obstacles from private insurance companies in getting the care they need because of unaffordable co-pays or coverage denials.
"Either we say, ‘That’s not acceptable but oh, that’s too bad,’ or we do something about it," Gottfried said.
Dr. Mitch Katz is head of the New York City Health and Hospitals Corporation, which oversees public hospitals in New York. He supports single-payer health care for the state. He said in his practice, he routinely encounters glaring holes in the private health insurance system.
"We’re currently in mediation with a for-profit insurance company that says that a 3-year-old boy brought to one of our emergency rooms with a fever of 103 and unresponsive should have been treated as an outpatient," Katz said. "No responsible doctor would have sent that child home."
He said another patient at his public clinic, a 60-year-old man, came to him after going to the hospital emergency room with breathing problems. The symptoms easily could have been alleviated with the use of an inhaler, but the insurance company required a $60 co-pay, more than what the man could afford. He expects the man will eventually end up in the emergency room again.
Assemblyman Phil Steck, a longtime supporter of single-payer health care, said individual New Yorkers and businesses already pay many hidden costs associated with health care. Speaking outside the hearing, Steck said the majority of county property taxes go to fund the Medicaid program, and businesses and their employees pay a fee for Medicare and workers’ compensation insurance. He said even a portion of auto insurance goes to cover health care costs.
"The question is, are we going to pay more or less in a single-payer system," said Steck, who believes there would be a 20% reduction in costs when you "cut out all that overhead."
A Rand Corp. study in August 2018 found that total health care spending would be slightly lower under the plan, but it would require $139 billion in additional state revenue to make the transition. Some state lawmakers, including Gov. Andrew Cuomo, say that amount is too high.
The Rand study also found that employers would ultimately pay less money under a payroll tax in the measure than they currently pay to health insurance companies for premiums.
Opponents include business groups, and many hospitals, as well as some labor unions. Kevin Dahill is with the Suburban Hospital Alliance, which represents hospitals in nine suburban New York counties. He said single-payer health care would "unquestionably" result in the closure of hospitals, because the reimbursement for services could be set at the current rates for Medicare and Medicaid, which pay about 80% of the actual cost of care. He said that’s not enough to pay all of a hospital’s expenses.
"We take care of those patients at a financial loss; that’s only made up by way of our negotiations with the commercial insurers," Dahill said.
Dahill said there would also be a significant loss of jobs, and he believes many workers who help patients and hospitals navigate the private insurance process would be eliminated. And he said if single-payer were enacted, New York’s entire private insurance industry would be wiped out, causing a negative "ripple effect" in the state’s economy.
Dahill acknowledged there are significant problems with New Yorkers getting adequate health care. But he said he believes they can be fixed through the current system. He said his hospitals have been talking to the organization that represents New York’s private insurers, known as the Health Plan Association.
"Some of those issues can and should be addressed," Dahill said.
An earlier version of the New York Health Act was approved in the state Assembly, long led by Democrats. Even though Democrats are in charge of the Senate now, and there are several sponsors, it’s likely to take a bit longer for a vote to be held.
The Senate sponsor, Gustavo Rivera, said he plans several more hearings on single-payer health care, which will occur after this year’s legislative session ends later in June.