Tim Joseph, Chair of the Tompkins County Legislature, makes a case for single payer health care in Sunday’s Times Union:
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.
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.
Tompkins County is a medium sized county in New York State, with a 2000 population of 96,500. As cumbersome as the current system is for Tompkins County, it can only get more so in larger and more diverse counties.
Of course, proposing single payer prompts the on-cue objection that Canada’s single payer system creates unreasonable waiting times for major surgeries. However, it is not the sytem, it is the resourcing of the system that accounts for wait times. This is the crucial distinction. Long waits imply shortages, which are not necessarily inherent:
Once upon a time, there were few complaints about lengthy waits for treatment. It was a time when the federal government provided about a third of the money the provinces spent on health care.
But as government belts tightened to deal with record budget deficits in the early 1990s, complaints about access to health care increased. The federal government drastically cut the amount of money it transferred to the provinces to cover health-care costs.
By way of analogy, I recall then-Mayor Rudy Giuliani arguing for education vouchers because the public school system was broken — after he had been cutting funding for public education.
The local taxes moral would be to watch where your county’s money is being spent as much as you watch out for whom you elect. And vice versa.