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Adirondack Almanac: North Country Looks At Single-Payer Health Care

By Bill Quinlivan, October 7

Recently, residents from around the North Country assembled in the Long Lake Town Hall to hear and participate in a meeting dedicated to better understanding the New York Health Act, the projected savings for Adirondack communities of this single-payer health-insurance program and where it currently stands in the state legislature.

Dr. Jack Carney of the North Country Access to Health Care Committee and member of the Long Lake Alliance moderated the evening’s program.  The program featured Dr. Andrew Coates as the keynote speaker.  Dr. Coates is assistant professor of medicine and psychiatry at Albany Medical College and past president of Physicians for a National Health Plan.

Dr. Coates started by explaining that the New York Health Act is contained in companion single-payer bills.  The first bill, A.4738, introduced by Assemblyman, Richard Gottfried, is joined by the companion bill S.4840, sponsored by Gustavo Rivera.  The New York Health Act passed the Assembly this past spring and is currently lodged in the New York State Senate Health Committee.

According to Dr. Coates, the single-payer plan established by the New York Health Act, if passed, would provide universal access to health care for all residents of the Adirondacks as well as all New Yorkers.  Coates further pointed out that this access would be comprehensive, providing medical, dental, and pharmaceutical coverage.

With regard to affordability, the plan would entail no deductibles or co-payments according to Coates.  In addition, it was pointed out that the plan would establish a “Trust Fund” from which all medical expenses incurred by those residing in New York State, including Adirondack residents, will be paid. With regard to the question of how this will be financed, it was explained that funding would come from funds already included in New York State’s budget, such as Medicaid, and that these funds would be augmented by “progressive assessments” based on income earned from employment and/or investments.

Coates pointed to the fact that back in 2015 the costs of the program were projected by Dr. Gerald Friedman, chairman of the economics Department at the University of Massachusetts at Amherst.  This past July, Friedman re-examined his analysis to assure it is still up to date.  In addition, Coates pointed to the fact that a recent separate re-examination was conducted by Dr. Leonard Rodberg of Queens College in New York City in August. Again, Coates points to the objective of the review being to determine the current appropriateness of Freidman’s original analysis.  According to Coates, both Friedman and Rodberg’s data are quite similar, allowing confidence in the projections.

According to the data, the New York Health Plan will require $254.9 billion annually to provide health care for all New Yorkers.  Friedman postulates that this amount would be garnered as follows:

  • Medicaid and other Federal subsidies: $99.5 billion
  • Progressive payroll assessments: $59.0 billion
  • Progressive assessments on dividends interest and capital gains: $32.4 billion
  • From Medicare (converted by Federal waiver to a NYS Medicare Advantage program for all New Yorkers 65+): $64.0 billion

With regard to the payroll assessments, it was explained that employed individuals receiving health benefits from their employers would pay 20 percent of the assessment and their employers would pay 80 percent.  For example, a worker making $30,000 per annum would pay $420 per year and the employer would pay $1,890 per year.

Further, Friedman’s analysis projects a reduction in current health-care spending in excess of 15 percent, or $45 billion annually, by 2019.  The savings would come from the removal of for-profit private health insurers from the health-insurance market in New York State, which would eliminate the cost of their overhead and profit.  Additionally, Friedman points to:

  • Reduced cost of employer administration of employee health benefits
  • Reduction in physician and hospital billing expenses
  • Reduced cost of prescription drugs and medical devices by way of single-payer negotiation with manufacturers.

Additionally, Friedman’s analysis points to savings due to counties in New York State no longer being obliged to contribute to the State’s Medicaid costs.  Just looking at upstate counties, Friedman projects such savings amounting to more than $1.3 billion or more than 46% of the $3 billion in property taxes collected annually.

In the packets provided to the attendees there was an analysis conducted by Dr. George Jolly of Saratoga Springs, which Carney and Coates provided to drive the savings argument a bit closer to home for the attendees to the Long Lake meeting.  The analysis is entitled, New York Health Act (NYHA): “Savings Accruing to Local Political Entities Due to Reduced Costs for Employee Medical Benefits.”  Projected savings data was shown for Hamilton County, towns and school districts:

  • Hamilton County = $1,713,000
  • Town of Long Lake = $491,725
  • Long Lake Central Schools = $873,483
  • Town of Indian Lake = $376,376
  • Indian Lake Central School District = $860,810.
  • Town of Newcomb = $525,807
  • Newcomb Central Schools = $885,365
  • Town of Minerva = $403,116
  • Minerva Central Schools = $970,849
  • Town of Johnsburg = $274,997
  • Johnsburg Central Schools = $2,353,535

The packet for attendees also contained an Executive Summary of the Friedman analysis.  The summary looks beyond the Blue Line toward the State as a whole.  Friedman points to the largest savings of the NYHA going to working households earning less than $75,000 per annum, adding that 98 percent of New York households would spend less on health care under the NYHA than they do now.

Beyond the quantitative projections, the executive summary claims that by lowering the burden of health insurance on business, the NYHA would make businesses in New York more competitive, drawing investment to New York to benefit from the reduced cost of doing business.  Finally, Friedman claims that the NYHA can be expected to create over 200,000 new jobs which would replace more than those lost in insurance, billing and insurance-related activities in providers’ offices.

For those interested in reviewing the Friedman analysis of NYHA a complete copy can be accessed here.