Do we want Single Payer?

To begin I would like to point out that I am conflicted over the notion of Government run Health Care for all. There are several reasons but to state the obvious I earn my living from the commission paid by the insurance companies when assisting people and businesses in attaining coverage. I am certain that I provide a needed service and that my role will disappear to the detriment of the enrollees. However, I am also of the opinion that as a technologically advanced and educated civilization (wishful thinking sometimes) I believe it is our duty to elevate the standard of care for all our citizens (at least) and provide “Health Care for All”.

What is Single Payer?

I am specifically responding to the NY Health Act when I say that the idea of Single Payer is to create a government monopoly whereby the government is the only entity negotiating rates directly with hospitals, doctors and other medical providers and is also responsible for paying them for covered services whenever they are needed. The idea is that eliminating the intermediaries (the insurance companies) and adding Federal funds already earmarked for Medicare and Medicaid and the Affordable Care Act will finance the administration and care costs. So, to recap: “Single Payer” is putting the government in charge of your access to and negotiating the costs and payment of your healthcare costs.

The formula which has been presented to communities, but which does not seem to appear in the NY Health Act is that those earning less than $25000 would not pay for coverage, those earning up to $400,000 would pay 10% of their income and only those who earn over $400K might pay more for their health care. Employers would be taxed to help cover their employees.

 

Pros?

• Theoretically, everyone will have access to the medical care they need.
• Providers, Doctors, hospitals other health care professionals, will have a lesser administrative burden in collecting their negotiated rates.

Cons?

• Government tends to create bureaucratic nightmares of administration. There is absolutely no accountability for government employees to be pleasant, helpful or knowledgeable. (NY State already runs a Health Care Marketplace, so we have an example of NYS administration of your access to health care)
• The NYS Health Act says that it expects to negotiate rates similar to those of the current rates negotiated by insurance companies. That is already an issue with providers and many providers choose not to participate with plans based on their low reimbursement rates. How will Providers afford to maintain quality if all their patients are paying the lowest rates, somewhere between 10 – 25% of their billed rates? Many doctors presently accept Medicare and Medicaid, but they could not possibly maintain a practice or any reasonable standard of care if it were their only fee structure.

Operations

The Board of Directors will be comprised a Commissioner, a Superintendent of Financial Services and a Director of the budget and of 19 additional Governor appointees, 5 of whom shall represent healthcare advocacy groups, 2 will represent physicians,  2 will represent healthcare providers other than physicians, 3 will represent hospitals, 1 will represent community health centers, 2 will represent health care organizations, 2 will represent organized labor, 2 will have expertise in health care finance, with 10 additional Governor appointees representing political bureaucracy. That adds up to a board of 32 members with none representing those “covered” under the NY Health Act and all being political appointees!

The NY Health Act will have “Care Coordinators” that are expected to ensure your access to the treatment you need. Again, it is not in the hands of the medical professionals but a 3^rd party government employee.

NYS already has some of the toughest oversite of the insurance industry in he US. The Department of Financial Services, DFS, approves the rates that insurance companies propose. If the Government is expected to be trusted to oversee and implement your access to Healthcare, why are they not doing that now?

Thoughts…

In 2016 8 CEO’s from the largest Health Insurers earned nearly $172 Million, that’s an average of $21 Million each.

Pharmaceutical costs and profits continue to soar in the US while Canada has been restricted from selling the same drug back to the US for less. Why does the US consume the greatest volume of drugs per capita at the greatest cost? Perhaps we can trust the government to investigate and regulate that?

Why tax employers to add to the funding? Why not offer coverage to all at an even playing field?

The myriad things that are wrong with the US system of Healthcare need to be addressed but I do not believe that Politicians and Governmental bureaucracy will do that adequately.

What do you think?