Why Single-Payer Health Care Saves Money Gottfried’s clarification of questions raised by article

July 11, 2017

This is a response by Assemblyman Gottfried to questions raised by the New York Times article I sent earlier today.

You can find it at:
https://www.nytimes.com/2017/07/07/upshot/why-single-payer-health-care-saves-money.html?smid=fb-nytimes&smtyp=cur

 

Here are my responses to a series of points someone recently sent me.  The person was responding to the pro-single-payer “Upshot” piece in the NY Times last week that Carlyn Cowen sent around.

 

Dick

 

what bugs me is the carelessness with the terms — single payer and medicare for all are too very different things to me. Medicare does not cover everything — so much so that many people have private insurance on top of it — and of course we have duals

A lot of the general public is not used to the term “single-payer,” so it sounds odd.  Everyone knows what Medicare is.  Single-payer advocates know that Medicare has gaps in coverage, requirements for co-insurance for many enrollees, etc.  So the term “Improved Medicare for All” became an alternative label for single-payer – with “improved” referring to broader coverage, no co-insurance, etc.  Calling it “Medicare for All” is just an abbreviation for “Improved Medicare for All.”  It’s a label, not a bill draft.

 

So the administrative savings in a medicare for all plan are not as universal as the article intimates — also people pay for medicare .

The article referring to “Medicare for All” is referring to a single-payer system.  The administrative savings under “traditional” Medicare are very real, and would scale up (perhaps even more so with better economies of scale and simplification) covering the whole population and without co-insurance.  Many single-payer critics misleadingly count the administrative costs of Medicare managed care (i.e., insurance companies) in with the costs of “traditional” Medicare.

 

I question if people really understand what single payer means — especially union members who almost certainly would have to pay more

Many people may not know what “single-payer” means, but I’m pretty sure people who say they are in favor of single-payer have a pretty good idea of what it is.

I think union members are keenly aware that their current plans nowadays usually have restricted provider networks, deductibles, co-pays, etc.; that the employers keep shifting more and more of the cost of the plan to the workers; and that the usually-retreating battle to protect the plan uses up almost all the union’s leverage at the bargaining table.

Under the NYHA, union members will almost certainly pay less.  They will have no deductibles, co-pays or restricted networks to deal with.  The payroll tax will be less than they the cost of the current plan (unless they are extremely high-paid workers  — e.g., unionized successful stockbrokers).  Employers will pay at least 80% of the payroll tax.  If the union has bargained the employer into paying a higher percentage of the health plan today, it will cut the same or better deal for the payroll tax; that will be easier to do, because the payroll tax will be less than the cost of the health plan.

 

And i personally still think any move needs to be federal — states that require balance budgets aren’t meant for this kind of thing — it’s too complicated to do in a recession when income tax revenue falls below projections — especially in a stated like new york where so much of our upper earned income is tied to wall street bonuses

It would be great to have the federal government do it – and when pigs have wings, they’ll fly.

The state’s balanced budget requirement is not an obstacle to single payer; whatever tax is dedicated to the single payer system will be raised or lowered as necessary to pay for the plan (and not for roads).

If economic fluctuation were set as an obstacle to major public programs, we wouldn’t have the fire department, the police department, public schools, Medicaid, public employee pensions, etc.  None of these things is a piece of cake, but they’re all important parts of how “to secure these rights, governments are instituted.”

A recession makes everything more difficult.  But it reallymesses up a health care system dependent on any combination of employment-based insurance or individual coverage.  All that gets wrecked in a recession, and the damage is most devastatingly inflicted on individuals who happen to lose their jobs or suffer investment losses.  A publicly system with broad-based funding is actually the most stable option.

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