Health care: Rigged against working people

There’s almost nothing more rigged against working people – or hits them harder in the wallet – than health care. And it’s a life-or-death issue. To make government more responsive to the needs of working- and middle-class people, and treat them with respect and fairness, health care is the place for New York to start.

While we try to stop Donald Trump and Republicans in Congress from degrading Medicaid and Medicare and wrecking the Affordable Care Act, we can work in New York to build a system that serves all of us.

Health care represents almost one-fifth of the economy, and an even a larger part of working people’s income. People are at the mercy of health insurance companies. Rising premiums, deductibles and co-pays; restricted provider networks; and out-of-network charges are real obstacles to health care and family financial stability. Each year, one in three families with private health insurance has someone put off care due to cost, usually for a serious medical condition.

The system is a major contributor to economic inequality, lack of opportunity and personal bankruptcies. The insurance company wants the same premium and imposes the same “cost sharing” whether you’re a multi-millionaire CEO or the receptionist struggling to make ends meet.

For a median-income household, insurance can cost over a quarter of family income (whether paid by the worker directly, or indirectly by the employer lowering workers’ wages). And that’s not counting possibly thousands of dollars in out-of-pocket costs. Employers continue to shift more costs to employees or drop coverage entirely.

Insurance companies tell us which doctors or hospitals we can go to and what care they can provide. Consumers fork over billions in administrative costs for health care providers to fight with insurers. It’s all a heavy burden on patients, health care providers, employers and taxpayers.

The Affordable Care Act made important repairs to the system. But it leaves insurance companies in charge.

As Trump and Congress move to privatize Medicare by turning it over to insurance companies, dismantle the ACA, give more power to insurance companies and cut Medicaid, millions of working people in New York will have less access to affordable health care.

When Trump and Congress say “repeal and replace Obamacare,” the agenda is eliminating financial help for low- and middle-income people who can’t afford high premiums and deductibles, shifting more of the cost of health care from insurance companies to consumers, and eliminating consumer protections. They talk about letting insurance companies sell in any state, but insurance companies already can do that. What they mean is making out-of-state insurance companies exempt from state consumer protection and financial solvency laws.

Their agenda will not help working people deal with health care; they will make things a lot worse.

But New York can choose a different path.

A progressive state can provide complete universal health coverage through an “improved Medicare for all” single-payer plan. In New York, the bill is called the New York Health Act. 

It would have no premiums, deductibles, co-pays, restricted provider networks or out-of-network charges – regressive “taxes” that hit working people hardest. Instead, New York Health would be funded fairly through a graduated broad-based tax based on ability to pay, on taxable income from employment, capital gains, interest, dividends, etc.

The doctors and hospitals you choose would provide care. The plan would cover all medically necessary services, including: primary, preventive, specialists, hospital, mental health, reproductive health care, dental, vision, prescription drugs, lab tests, and medical supplies – more comprehensive than commercial health plans.

The New York Health plan will treat patients and health care providers more fairly because all of us – rich and poor – will be covered. If elected officials don’t keep the quality high, they’ll face political consequences. That’s what has protected Medicare against years of attacks.

New York Health would save us tens of billions a year. Taking insurance companies out of the picture would save billions in private insurance company administration and profit and the billions doctors and hospitals spend to fight with insurers. It would save by negotiating prices of drugs and medical devices. Employers wouldn’t spend billions on reviewing, selecting and administering health benefits.

Working people would benefit because the lower total cost would be funded based on ability to pay.

The New York Assembly passed the bill in 2015 and 2016 – helping to move it from being “a great idea that could never happen” to something really achievable. In 2017, we’ll continue to work to build public support so it can ultimately pass the Senate.

People talk about making government respond to the needs of working- and middle-class people. A state “improved Medicare for all” plan is a key actionNew York can take.

Richard N. Gottfried is a state assemblyman representing Manhattan and the chair of the Assembly Committee on Health.