By TIM JOSEPH
Times Union
First published: Sunday, November 4, 2007
Gov. Eliot Spitzer has formed a task force to examine how to achieve universal health care access in New York. There are two fundamentally different approaches that can be taken to solve the problem.
One is to build on the current patchwork of employer-provided insurance, Medicare, Medicaid, Child Health Plus, Family Health Plus, individual pay as you go, indigent care provided by emergency rooms, etc. This approach involves making the health care system more complicated by adding patches to cover people currently left out.
The other approach is to replace the current system with a single government-managed health insurance system, sometimes called “single payer” or “Medicare for all.”
As an elected county leader, I find that a tremendous amount of my time, and my county’s budget, is devoted to one or another aspect of health care for some segment of our citizens. Nearly all of that time is devoted not to delivering health care, but to sorting out who will pay for it.
A big advantage of a single-payer system, compared with our current patchwork, is that it resolves this issue once and for all, and thus offers substantial savings in administrative costs.
Every estimate I’ve seen of those savings overlooks the myriad hidden costs associated with our current system. Here are just a few of those costs I encounter every day:
My county, like every county in the state, has an Office for the Aging. We have a 10-person staff. The largest part of their work consists of helping seniors navigate the health care system, find programs available to help them, and plan how they will manage health care costs now and in the future.
Our personnel department includes a full-time benefits manager who is mostly occupied with assisting employees in dealing with the health insurance program. Those employees lose productive work time consulting with the benefits manager and fighting insurance company denials, which can take hours from the workday.
When we negotiate with our employee unions, health care is always the biggest topic. We have a health care consultant on retainer to help us examine and cost out plan changes that we present to our unions in an attempt to control costs. At least two-thirds of the staff time devoted to collective bargaining is spent on health care issues.
We devoted hundreds of hours of staff time to developing and publicizing a discount prescription card available to all county residents to reduce drug costs for those without insurance.
We have a $400,000 state grant to form a health insurance consortium among local governments to purchase employee health care as a larger group. We will hire a consultant to help us form that consortium and find a suitable plan. Various county staff devotes substantial time to this project.
We have staff in our mental health, public health and social services departments devoted to collecting fees from private insurers to reduce the public cost of programs that deliver various health services.
We have people waiting in jail whom judges are prepared to release to drug or alcohol treatment programs as soon as we can assure payment to the treatment center. Staff in local agencies and our Department of Social Services work on getting these inmates into health care programs, mainly Medicaid, that will cover treatment. Meanwhile, we pay the cost of incarceration.
Our economic development staff encounters aspiring entrepreneurs who would like to start their own businesses, but are tied to a job by the health insurance benefits. Meanwhile, new businesses often have trouble attracting the employees they need, because they cannot yet offer a health plan.
We have staff who don’t like their jobs and perform at less than the desired level, but who remain because they need the health insurance.
Nurses and other health care professionals routinely leave direct service to take jobs in insurance companies, contributing to our severe shortage of nurses and physicians.
This is just a partial list of the many ways county government and local economies spend time and money dealing with the question of who will pay for health care.
None of these costs are ever included in comparisons between single-payer and other health care systems, but every one of them would go away if there was a single, simple and consistent answer to the question, “Who will pay?”
Only a single-payer system will accomplish that.
Tim Joseph in chairman of the Tompkins County Legislature.