More than 33 percent of all Americans cannot access needed medical care due to money.
A single payer tax-prepaid health service is not necessarily a socialistic solution. Canada, a capitalistic country, has a single-payer system. The difference between Canadian capitalism and the American version is merely over who the payer is: the government, as opposed to a combination of patients and their insurers. The American system is the one where care is rationed: insurers ration care when they review records and decide to reduce physician payments or terminate the level of care received.
Patients ration their care when they can’t afford either co-pays or medication needed to treat their ailments. Not to mention the lack of true parity for mental health, vision and dental care.
Under the Affordable Care Act, states are encouraged to innovate their health care systems. The proposed New York Health Assembly Bill (Senate bill S.2078-A) currently under consideration in the New York Legislature is an opportunity to offer a single-payer system. Under this bill, every New York resident would be covered, regardless of their age, their income, their savings, their employment or their legal status. Residents desirous of medical care would simply flash their eligibility card in front of the receptionist to receive services. There are no co-pays or deductibles. Doctors would bill the Health Department for services. Tests and prescriptions are all covered.
Doctors and hospitals remain private: they negotiate patient care directly with the patient. New York Health would just pay the bills. No medical bankruptcies. No loss of employer coverage when sickness trumps employability.
Current taxes and fees could cover the bulk of it via the state payroll tax. Non-payroll income, such as capital gains, dividends and interest would also be used to fund New York Health. Perhaps taxes would rise — however, overall, costs for the individual would decrease — no more premiums, deductibles, co-pays and out-of-network minimums, which after all, constitute a de-facto negative tax. Property taxes will decrease as local share of Medicaid funding would end.
The average cost of an employer-provided family plan in New York is over $17,500/year with an average family deductible of over $2,200. The average individual spends over $6,000 a year for health care premiums. Overall health care costs will decrease as the profit that insurance companies must have (up to 30 percent of the health care dollar) will disappear. Doctors’ administrative costs will decrease, as there will be no need to have billing specialists whose sole job is to negotiate with various insurance companies. Under single-payer, Federal funds currently utilized for Medicare, Medicaid, Family Health Plus and Child Health Plus would be combined with the state revenue in a health trust. New York would receive a federal waiver so that the new single payer option—New York Health, would be enveloped within Medicare, Medicaid, Family Health Plus, Child Health Plus, ACA benefits and any other federally funded program.
The ACA was based on the notion that federal aid would enable citizens to buy insurance via subsidies — it did not predict that insurance companies would then raise their premiums to ensure their profits would never be used to pay for health care costs, a perpetual game of keep away. The growth in the net cost of health insurance is due to administrative waste and executive profits. ACA further assumed that states would expand Medicaid coverage — and approximately half did not. New York Health would offer both affordable as well as accessible health care.
Sharon R. Kahn has earned a doctorate in psychology and holds state licensure as a psychologist. She lives on the Upper East Side.