State Assembly points the way forward on health care
Andrew D. Coates, MD
Poughkeepsie Journal
June 13, 2008
Supporters of national health insurance - a single-payer system of nonprofit, public financing that would guarantee quality health care to every one of us - were just getting used to being compared to Don Quixote.
Our critics smile at us and say that national health insurance a great idea, but they add a wink, for they believe the insurance companies are simply too rich and too powerful. The not-so-subtle message: give up and prepare for compromise with the private insurance industry.
Enter the New York State Assembly, not known as a den of starry-eyed idealists, with an overwhelming vote of support for single-payer health reform.
On May 27, the State Legislature’s lower house decisively adopted a resolution backing a federal proposal, H.R. 676, the “U.S. National Health Insurance Act,” sponsored by Rep. John Conyers of Michigan. The Congressional bill’s 90 co-sponsors include New York Representatives Yvette Clark, Eliot Engel, Maurice Hinchey, Carolyn Maloney, Michael McNulty, Gregory Meeks, Jerrold Nadler, Charles Rangel, Jose Serrano, Edolphus Towns and Anthony Weiner.
The chief sponsor of the May 27 resolution was Assemblyman Felix Ortiz (D-51, Brooklyn). The measure was also pushed by a coalition of labor groups, doctors and nurses, religious groups, anti-poverty and human rights organizations. A similar measure in support of H.R. 676 was adopted in 2007 by the Republican-led Rensselaer County Legislature.
Noting that approximately 2.6 million New Yorkers currently lack health insurance, that people who have insurance are often burdened with “unacceptable medical debt” that frequently leads to bankruptcy, and that all New Yorkers face “sometimes life-threatening delays in obtaining health care,” the N.Y. Assembly unambiguously declared itself in support of the single-payer approach. By calling for passage of a bill in the U.S. Congress, they acknowledge our need for a nationwide solution.
The single-payer model has accumulated new support because of the failure of compromise after compromise with private health insurers in state after state.
Massachusetts’ mandate model has reduced the percentage of uninsured through state-subsidies for private health insurance for low-income families but generated a spectacular deficit. The plan also failed to provide for an influx of new primary care patients and failed to eliminate excessive out-of-pocket costs including co-pays and deductibles. Further, the middle class uninsured who have been “mandated” to buy private health without a state subsidy (or else pay a fine) simply cannot afford the premiums.
Meanwhile the single payer model has already proved its effectiveness in country after country.
Taiwan recently adopted single payer. Like other nations that have national health insurance, health costs been brought under control. More striking, the new system has improved health outcomes. Significantly, disparities in the quality of care for the affluent vs. the poor have been lessened in Taiwan, with life expectancy among low-income people in rising most dramatically. (In contrast, life expectancy for American women in 1,000 U.S. counties, poor and rural areas, actually declined for the first time in our history during the 1990s.)
Single payer health financing delivers better care, better medical outcomes at a lower cost through a basic democratic method: by sharing health risks and needs across the whole public. In this era of evidence-based medicine, the evidence is in: single payer is the way to go.
The New York State Assembly’s action demonstrates that those who smile knowingly and call for compromise with the private insurance industry are seriously out of touch with popular opinion.
An exaggeration? Consider this: over 430 labor organizations, including 33 state chapters of the AFL-CIO, have endorsed H.R. 676. The Capital District Area Labor Federation and the Troy Area Labor Council have also endorsed H.R. 676. These organizations have also helped organize local participation in an upcoming nationwide day of protest: “Healthcare YES! Insurance companies NO!” They will rally, with other groups, outside of the 90 State St. office of the New York Health Plan Association on Thursday, June 19th at 5 p.m.
Some 59 percent of doctors now support national health insurance, up from 49 percent only five years ago. In Minnesota, New Hampshire, Massachusetts and New York, when polled, nearly two-thirds of physicians and surgeons support single payer.
Last December an Associated Press poll showed strong public support - 65 percent - in favor of “a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.”
These figures, and the Assembly’s resolution on H.R. 676, give further expression to a gathering, unstoppable movement for fundamental health care reform, confirming Victor Hugo’s estimate that “there is nothing more powerful than an idea whose time has come.”
Minor tweaks in our deeply flawed system simply aren’t enough. The private health insurance industry, which skims off such a big share of each health care dollar in administrative costs, marketing, outsized profit-taking, and outlandish CEO salaries, has outlived its usefulness. It’s time to move on.
We should be proud that our Assembly has helped point the way forward. Let’s make this a banner year for moving toward a more effective and compassionate health care system: single payer.
Andrew D. Coates, M.D., practices and teaches medicine in Albany and is secretary of the Capital District (N.Y.) chapter of Physicians for a National Health Program (www.pnhp.org).