November 27, 2021

Rx for health care?

Proposed statewide single-payer health care gets mixed reactions

Catherine Wilde/contributing photographer

Family Health Network Internist Nicole Villapiano checks out Debbie Underwood on Monday. Villapiano says a single-payer health care system could result in better health outcomes for patients but would have to be researched thoroughly to make sure it is implemented well. The state Legislature is considering enacting a single-payer system.

Nicole Villapiano listened to Debbie Underwood’s heartbeat and breathing Monday at Family Health Network’s clinic on West Road in Cortlandville.

An internist, Villapiano sees many patients like Underwood each day; patients she says would be better served by a single-payer health care system, similar to one state legislators are considering.

It would eliminate the complexities of a third-party insurance system that causes confusion for both patients and doctors, Villapiano said.

The New York Health Act now in committee has its opponents, including the Business Council of New York State, the New York State Conference of Blue Cross and Blue Shield Plans, the New York State Association of Health Underwriters, the Greater Binghamton Chamber of Commerce and Hematology Oncology Associates of Central New York, according to the Realities of Single Payer, a coalition of opponents.

State Sen. Jim Seward (R-Milford), who also sits on the Senate Insurance Committee, of which he is a past chairman, doubts it will pass this year, and would rather, like the coalition, pursue other measures to broad access to health care. But Assemblywoman Barbara Lifton (D-Ithaca), said she believes the climate could be favorable for the bill to pass this year, given the new Democratic-controlled Senate.

Gov. Andrew Cuomo has said he supports the idea of single-payer healthcare, but enacted at the federal level, not the state. In his State of the State address this year, he announced a commission to, among other efforts, strengthen the commercial insurance market.

Nevertheless, state Sen. Gustavo Rivera (D-Bronx) and Assembly Health Committee Chairman Richard Gottfried (D-Manhattan) sponsored the act, and there have been pushes to enact it.

Public replaces private

A single-payer health system would eliminate for-profit private health insurance providers while creating a government healthcare system. People would pay based on their ability and income levels.

In theory, Villapiano said, this is good. Much of what she and her nurses do every day is navigate the complexities of third-party insurance providers.

“Physicians and providers are largely in favor of a single-payer system because it’s associated with better health outcomes and it makes our job easier,” Villapiano said, speaking personally. “We could just focus on the patient.”

Additionally, the United States lags other industrialized countries in two major health indicators: life expectancy and infant mortality, Villapiano said.

“There’s a lot of data showing that a single-payer system is associated with better health outcomes,” she said.

According to Campaign for New York Health, a coalition of 150 supporters of the act, people making up to $25,000 yearly wouldn’t pay anything for coverage. As income increases, the employee contributes more, paying $9.30 a month if they make $31,000, and paying $132.67 a month if they make about $100,000.

Deductions would also be taken from those who have income from stocks, dividends or capital gains.

Seward says he is gravely concerned about the bill, mostly because of its expense.

“We estimated that if New York state was to do this on our own the first year alone, we’d have to raise taxes like $139 billion to support this, which would mean a significant tax increase,” Seward said.

Higher taxes, lower costs

However, an analysis by the nonprofit think tank the Rand Corp. suggests the New York Health Act could save consumers through lower insurance premiums.

The state’s total cost for health care would dip slightly, to $309 billion from $311 billion in 2022, but the savings would increase to $15 billion a year by 2031.

Maybe. “Our results suggest that a single-payer approach has the potential to lower payments among most New Yorkers, but the results are sensitive to assumptions about uncertain factors, such as the state’s ability to reduce provider payment rates and administrative expenses, and the response of high-income residents facing new taxes,” states Rand’s report, published last year.

Seward is also concerned that if New York state does this on its own, people would leave the state.

“The flee and flight of people out of New York would be greatly accelerated, particularly those paying the taxes and working and the higher income individuals would flee New York in greater numbers,” he said.

Instead, Seward would rather see greater focus on getting coverage for the 4 to 5 percent of the population that is uninsured or underinsured.

“Those that are eligible for existing programs or private health insurance that’s working for them, let’s not upset that apple cart, let’s zero in on the remaining uninsured,” he said. “I think that is financially much more feasible than this broad program that would involve everyone that I think is just way too expensive.”

However, The Rand Corp. reported, “We estimate that, on average, people with household compensation below the 90th percentile would pay less under NYHA under the status quo, but the highest-income households would pay more on average.”

Villapiano said focusing on covering the uninsured is a good idea, however, she disagrees with the idea that most people are happy with the plans they have.

“We still aren’t doing the best job we can for everybody else who isn’t happy with their insurance, to make the care and delivery better for everybody,” she said.