Cure for Ailing Health Care

The longer the discussion continued, the clearer it became that neither the panelists nor the audience at a New York Health Act forum on Saturday afternoon had come to debate the merits of the proposed bill. Rather, they had come to talk about why it finally needs to become law. 

The panelists at the event, held at the Stony Brook Southampton campus, spoke about the bill’s revolutionary promises and lamented “misinformation” campaigns against it that, they said, were motivated primarily by a simple fear of change. And the audience, judging by the questions asked of the panel, seemed to find little downside to the bill, which was reintroduced in the New York State Assembly on Monday. 

The health act had repeatedly stalled in the state senate in recent years but, now that both chambers of the state legislature are controlled by Democrats, it is given a strong chance of passage.

“Remember how Churchill said Americans can always be counted upon to do the right thing — after they’ve exhausted every other possibility?” said panelist Martha Livingston, a professor at SUNY-Old Westbury and chairwoman of that university’s public health department. “I think we’ve exhausted every other possibility.”

Ms. Livingston and Assemblyman Fred W. Thiele Jr., a co-sponsor of the bill, stressed the many benefits of the proposed legislation. So did the moderator, Cheryl Cashin, a health economist and managing director of Results for Development, a global nonprofit. Amy Reich, a nurse at East End Pediatrics with deep experience in hospital and oncology settings, and David Mayer, the owner of a prosthetics company, also shared their firsthand experiences and critiques of the current system.

The forum was co-sponsored by Progressive East End Reformers (PEER) and more than 20 East End organizations and churches.

The panelists were in agreement that the public should be made aware that the N.Y.H.A. would not change the health care delivery system in New York. The proposed system would be composed of the same networks of doctors and hospitals that New York residents already rely on. What would change is how those places get paid. The act would create a “single payer” — i.e., the State of New York — that would reimburse health care providers much in the same way that the federal government pays Medicare patients’ bills now.

The big shift would be the disappearance of health insurance companies, which would be pushed out of New York State. 

They are not expected to go quietly.

“The insurance industry is massing at the border of Albany, even as we speak,” Mr. Thiele said. “This time [the chance of passage] is real. . . . And the insurance industry will be lobbying with full force.” 

By Mr. Thiele’s count, 35 of the 63 members in the newly elected, more progressive state senate have expressed support for the N.Y.H.A. 

Gov. Andrew M. Cuomo has not yet indicated if he would sign the bill. 

The panelists cited numerous reasons why the N.Y.H.A. plan makes sense for everyone — everyone except the insurance industry, which, Ms. Livingston said, currently enjoys profit margins of 15 to 33 percent and freer rein to charge what she termed “obscenely high prices” for premiums, services, and medications.

Ms. Reich detailed some of the roadblocks to care she has seen during her nursing career. She spoke about the stress endured by sick patients and their families, who often have to battle insurance companies for coverage and payments, and about doctors and nurse-practitioners who are often forced to spend a great deal of time negotiating with insurance companies to justify the treatment plans they have prescribed.

Mr. Mayer nodded as Ms. Reich spoke, then gave a real-life example: He said his company was contacted by an insurance company once and asked why a patient who had just undergone a leg amputation would need a prosthetic limb.

“That was literally the question,” he said.

Such challenges to the judgment of the provider and similar bureaucratic hurdles to treatment are “not present in any other country I can think of,” Ms. Cashin said, noting that America is one of the last affluent countries to resist a universal health care system. Canada has had one since 1962.

The proposed N.Y.H.A., as currently written, would provide all New Yorkers with cradle-to-grave coverage regardless of their age, wealth, income, or pre-existing conditions. Coverage would be provided for primary and preventive care, all medically necessary inpatient and outpatient care, as well as prescriptions, vision, hearing, and dental costs. 

There would be no co-pays, deductibles, or other charges for patients beyond their insurance premium. Participants would also be free to choose whichever doctor or health provider they wanted, rather than choosing from an insurance-company network list.

  Coverage for long-term care was added to the latest version of the bill, which was re-introduced on Monday. 

A state agency, called New York Health in the proposal, would administer the program. It would be paid for through a progressive state payroll tax on employers and employees that supporters contend would work out to a smaller percentage of an individual or family’s income than they currently spend on health care. One potential sticking point is that the state would have to seek a federal waiver to combine this funding with the federal money it currently receives for Medicare, Medicaid, and Child Health Plus. 

As Mr. Thiele said, “We are mindful of who is in Washington right now.”

Critics of the N.Y.H.A. question if it would really deliver the boon of market efficiencies, services, and savings as claimed. They also charge it could be a nightmare to administer and would cripple businesses that currently do not provide employee health insurance. 

A few of the panelists acknowledged that battle-weary residents, worn out by decades of trouble in the health care sector and ever-escalating medical bills, might find it hard to believe that they would suddenly be blessed with far better coverage and lower costs if the health act were to pass. As Ms. Livingston deadpanned, “The guys on the other side of this argument will like you to believe every pregnant woman in Canada waits 10 months for prenatal care.” She insisted, however, that other countries’ universal care systems do work: “If you’re sick, you’re covered. And last I checked, only 106 doctors in Canada opted out.”

Mr. Thiele noted two recent independent studies that have shown that 90 to 98 percent of all New Yorkers would pay less for health care if the N.Y.H.A. passes. Passage, he said, would help not only the 5 percent of state residents who have no insurance but also the 95 percent who do.

Several panelists said the Affordable Care Act that was passed during the Obama administration was a good start, but that it did not go far enough, because the for-profit insurance industry was not cut out of the equation.

Ms. Livingston said health care in America was a $3.3 trillion industry last year that ate up one-sixth of America’s gross domestic product — that is, one of every six dollars spent.

“And yet all of that money isn’t actually going to health care,” she said, referring again to the double-digit profit margins insurance companies take off the top. “The bottom line here is there is no scarcity [of money] in this system. We could cover everyone for everything and pay everybody for doing it. But we need to get the insurance companies out.” 

Mr. Thiele agreed.

“The bottom line is we’d have better health care, period, with this act,” Mr. Thiele said. “We think we can get better care, provide more coverage, and save money.” 

A video of the entire N.Y.H.A. forum can be seen on the PEER/NYPAN Progressive East End Reformers Facebook page.