Saturday, October 7, 2017

North Country Looks At Single-Payer Health Care

Recently, residents from around the North Country assembled in the Long Lake Town Hall to hear and participate in a meeting dedicated to better understanding the New York Health Act, the projected savings for Adirondack communities of this single-payer health-insurance program and where it currently stands in the state legislature.

Dr. Jack Carney of the North Country Access to Health Care Committee and member of the Long Lake Alliance moderated the evening’s program.  The program featured Dr. Andrew Coates as the keynote speaker.  Dr. Coates is assistant professor of medicine and psychiatry at Albany Medical College and past president of Physicians for a National Health Plan.

Dr. Coates started by explaining that the New York Health Act is contained in companion single-payer bills.  The first bill, A.4738, introduced by Assemblyman, Richard Gottfried, is joined by the companion bill S.4840, sponsored by Gustavo Rivera.  The New York Health Act passed the Assembly this past spring and is currently lodged in the New York State Senate Health Committee.

According to Dr. Coates, the single-payer plan established by the New York Health Act, if passed, would provide universal access to health care for all residents of the Adirondacks as well as all New Yorkers.  Coates further pointed out that this access would be comprehensive, providing medical, dental, and pharmaceutical coverage.

With regard to affordability, the plan would entail no deductibles or co-payments according to Coates.  In addition, it was pointed out that the plan would establish a “Trust Fund” from which all medical expenses incurred by those residing in New York State, including Adirondack residents, will be paid. With regard to the question of how this will be financed, it was explained that funding would come from funds already included in New York State’s budget, such as Medicaid, and that these funds would be augmented by “progressive assessments” based on income earned from employment and/or investments.

Coates pointed to the fact that back in 2015 the costs of the program were projected by Dr. Gerald Friedman, chairman of the economics Department at the University of Massachusetts at Amherst.  This past July, Friedman re-examined his analysis to assure it is still up to date.  In addition, Coates pointed to the fact that a recent separate re-examination was conducted by Dr. Leonard Rodberg of Queens College in New York City in August. Again, Coates points to the objective of the review being to determine the current appropriateness of Freidman’s original analysis.  According to Coates, both Friedman and Rodberg’s data are quite similar, allowing confidence in the projections.

According to the data, the New York Health Plan will require $254.9 billion annually to provide health care for all New Yorkers.  Friedman postulates that this amount would be garnered as follows:

  • Medicaid and other Federal subsidies: $99.5 billion
  • Progressive payroll assessments: $59.0 billion
  • Progressive assessments on dividends interest and capital gains: $32.4 billion
  • From Medicare (converted by Federal waiver to a NYS Medicare Advantage program for all New Yorkers 65+): $64.0 billion

With regard to the payroll assessments, it was explained that employed individuals receiving health benefits from their employers would pay 20 percent of the assessment and their employers would pay 80 percent.  For example, a worker making $30,000 per annum would pay $420 per year and the employer would pay $1,890 per year.

Further, Friedman’s analysis projects a reduction in current health-care spending in excess of 15 percent, or $45 billion annually, by 2019.  The savings would come from the removal of for-profit private health insurers from the health-insurance market in New York State, which would eliminate the cost of their overhead and profit.  Additionally, Friedman points to:

  • Reduced cost of employer administration of employee health benefits
  • Reduction in physician and hospital billing expenses
  • Reduced cost of prescription drugs and medical devices by way of single-payer negotiation with manufacturers.

Additionally, Friedman’s analysis points to savings due to counties in New York State no longer being obliged to contribute to the State’s Medicaid costs.  Just looking at upstate counties, Friedman projects such savings amounting to more than $1.3 billion or more than 46% of the $3 billion in property taxes collected annually.

In the packets provided to the attendees there was an analysis conducted by Dr. George Jolly of Saratoga Springs, which Carney and Coates provided to drive the savings argument a bit closer to home for the attendees to the Long Lake meeting.  The analysis is entitled, New York Health Act (NYHA): “Savings Accruing to Local Political Entities Due to Reduced Costs for Employee Medical Benefits.”  Projected savings data was shown for Hamilton County, towns and school districts:

  • Hamilton County = $1,713,000
  • Town of Long Lake = $491,725
  • Long Lake Central Schools = $873,483
  • Town of Indian Lake = $376,376
  • Indian Lake Central School District = $860,810.
  • Town of Newcomb = $525,807
  • Newcomb Central Schools = $885,365
  • Town of Minerva = $403,116
  • Minerva Central Schools = $970,849
  • Town of Johnsburg = $274,997
  • Johnsburg Central Schools = $2,353,535

The packet for attendees also contained an Executive Summary of the Friedman analysis.  The summary looks beyond the Blue Line toward the State as a whole.  Friedman points to the largest savings of the NYHA going to working households earning less than $75,000 per annum, adding that 98 percent of New York households would spend less on health care under the NYHA than they do now.

Beyond the quantitative projections, the executive summary claims that by lowering the burden of health insurance on business, the NYHA would make businesses in New York more competitive, drawing investment to New York to benefit from the reduced cost of doing business.  Finally, Friedman claims that the NYHA can be expected to create over 200,000 new jobs which would replace more than those lost in insurance, billing and insurance-related activities in providers’ offices.

For those interested in reviewing the Friedman analysis of NYHA a complete copy can be accessed here.

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The Adirondack Almanack publishes occasional guest essays from Adirondack residents, visitors, and those with an interest in the Adirondack Park. Submissions should be directed to Almanack editor Melissa Hart at


19 Responses

  1. Christine Denno says:

    “Progressive assessments” = more taxes, on income AND my investments.. I heard that the Democrats were cooking this up…..taking my hard earned retirement savings. I hope I die first.

    BTW, I agree that we need a different system than we have now. For the last 15 years of employment my husband and I paid for 100% of our health insurance. The last year it was $1550 a MONTH, for $1000 deductable with 20% of the remainder. We could barely afford it.

    The cost of health care will never go down as long as OVER 50% of us are overweight, with many of those obese. In an ideal world we would all have everything we need, but we do not live in such a world.

    • Boreas says:

      Any national healthcare system is going to take your taxes. The idea of single-payer in most modern countries is to reduce or eliminate premiums, co-pays, deductibles, etc. and shifting it toward taxes/payroll deductions similar to Medicare. Essentially it would increase Medicare taxes. Do you have a complaint about Medicare?

      The main savings from single payer or Medicare for all are the elimination of very profitable 3rd-party companies adding unnecessary costs, and nationalized negotiation of medicine costs, bringing them down to the rate the rest of the world enjoys.

      I also wouldn’t point to any one disease as causing the crisis. They ALL are the cause. If you think about it, isn’t getting old really the problem? That is when healthcare costs skyrocket. Perhaps to reduce costs citizens should be euthanized over the age of 40. BTW, that is a joke.

    • Bill Quinlivan says:

      One of the things a lot of people don’t understand is that now we have an invisible single payer and that payer is you the taxpayer. Who we think absorbs the cost of the uninsured who are going to emergency care for primary care needs. The taxpayer is footing the bill and the bill is not readily seen or identified, but it is there. In addition, since the more fortunate of us have access to tax loopholes or reduced rates due to passive income from investments being taxed at low “capital gains” rates, the less fortunate are carrying a greater proportion of this hidden cost. Single payer appears to level the playing field, eliminate the inefficiency and ineffectiveness from the system that is introduced by insurance companies.

  2. Danny Knapp says:

    The symbol you have pictured is the caduceus. It’s commonly used in reference to healthcare in the US, but the true symbol of healthcare is the Rod of Asclepius which is one snake around a staff, without the wings.

    There are various accounts of how this mistake came to pass, but what is interesting is that while the Rod of Asclepius is a symbol of healing and medicine; the caduceus which is so popular in US healthcare is a symbol associated with Hermes, the god of commerce and holder of the fat purse.

  3. Kathy says:

    Sounds as tho you could then use the $1550 per month and the $1000.00 deductible you pay for health insurance for your retirement saving if this was adopted unless the increased tax to pay for it exceeded your monthly premiums and Co pays??

    • Christine Denno says:

      We’re 69, so on Medicare now, and have great coverage for about $200 a month, for Medicare and BC/BS supplemental.

      We need a different system, but it’s more complicated than most people realize. When we paid (in 1012) $1550 for a couple, the cost for a single was $600, and for a family ANY number of people) was about $1850. So the couple subsidized the singles and the families…..?????…..WHY????

      And, as private payers we had to join a group (That’s how insurance works folks….share the risks.). This group kept $150 an month, EVERY MONTH, and provided nothing. They never even revealed this to us until the last two years…..I assume they were forced to by law.

      And then there is the obesity problem even in children, and all kinds of socially acceptable, but risky behavior. And how about doctors pushing tests and treatments on people nearly dead of something not related. Don’t forget, doctors make $$$$$ on our problems.

      The problem is HUGE, and letting the government handle (dole it out???) is not necessarily the best solution. I don’t trust government statistics. Consider human nature. No…..I do not have a solution.

      • Kathy says:

        Am I confused or isn’t Medicare the government? If you don’t have a problem with Medicare how would it change ??
        Single payer is just Medicare for all ???

      • Boreas says:


        There is no ‘single best’ solution. But most of the world has left the US in the rearview mirror with regard for affordable, practical healthcare. Other countries happy with their healthcare have various versions of single-payer – whether administered by the government or a single private entity subsidized by government and taxes.

        The only people who benefit from our current “system” (excluding Medicare/Medicaid) are third-party providers (insurance companies), lawyers, and politicians who rely on the insurance lobbyists.

        If you think doctors are getting rich from the current mess, think again. I am still paying off 20 year-old school loans. Doctors order a lot of tests in the US because of the threat of litigation if they leave one test out. AND, they can only order tests or prescribe medicines the insurance company allows. Ask any doctor about his/her malpractice ‘insurance’ – there’s that word again! Get the picture? When was the last time you heard of ANY insurance company going out of business? They will cover their risks and losses with increased premiums or decreased payouts. Add these insurance costs to price gouging on medications (even generics are being gouged now!) and you have our current situation.

        Tweaking the ACA or scrapping it and putting in something similar with all the same players will not solve anything. It is the third-party system combined with exorbitant maintenance drug costs and excessive litigation that is causing the problem, not disease and doctors.

  4. Jim Fox says:

    Of course you’ve “heard the Democrats were coooking this up”, this is the deep red North Country. It sounds to me like a carefully researched, and re-analysed plan that will benefit people. Watch now what the NY health insurance lobby “cooks up”. You betcha that’ll be fake news.

  5. Charlie S says:

    Christine Denno says: “I heard that the Democrats were cooking this up…..taking my hard earned retirement savings. I hope I die first.”

    I hear these words a lot, ‘Taking my hard-earned dollars away….’
    And often after those words are the words ‘just to help them poor b#!*/’s out who don’t wanna work, etc…’ Always those of that blood-red political persuasion it is who put this, by now, stale line out. Let us face it! Both parties are sapping us from our hard-earned dollars in some degree or another but…………

    I cannot help but go political here after reading the above line from Christine Dunno. Wasn’t it your base that almost wholly supported that horrible Iraq War which we are still paying dearly for Christine? That horrible unjust war which broke up that whole area and which nobody seems to talk about anymore? Which killed so many of our brothers and sisters? Which killed so many innocent Iraqi men, women and children. Which is still costing us dearly and which added more than $1 trillion to the U.S. debt and continues to add to our debt!!!!!!!!! Which has made this world (not coincidentally) a much unsafer place to live.

    I will never relate to a mindset that is abhorrently against any kind of taxpayer dollars going to help his or her fellow man out yet will support taxpayer dollars going to support horrible wars. Or sports stadiums….. Very weird to me but than I have come to expect as little from a Tory.

    You may very well die first Christine. We all may what with these neocon-kooks in power who just always seem to want to wage war against anybody or thing that gets in the way of their self-serving, narrow, ideological views of this world.

  6. Charlie S says:

    Boreas says: “Doctors order a lot of tests in the US because of the threat of litigation if they leave one test out.”

    Doctors are also killing patients Boreas by prescribing the wrong treatments or doing something wrong….and getting away with it.

    • Boreas says:


      More costly tests certainly aren’t the answer to limiting those types of patient deaths. Perhaps better trained doctors in an environment where they have time to think and therapeutic protocols aren’t determined by insurance companies. Again, the rest of the industrialized world manages somehow. It’s at least worth a listen…

      • Charlie S says:

        And did you realize we have to sign off before they perform any surgery, even to pull a tooth, that exempts them from being sued in case we die during the procedure Boreas? Tell me our government is looking out for us hey?

        • Boreas says:


          I do realize that, but don’t think for a moment doctors, staff, and hospitals still can’t be sued for bad outcomes – regardless what has been signed. If that were the case a lot of lawyers would be out of work. But try to sue a third- party insurance company for a bad outcome because of their protocols – they can afford a lot of lawyers.

          I don’t understand what your point has to do with single- payer vs. ACA. Anywhere you have sick patients and doctors you are going to have bad outcomes, mistakes, and wrongful deaths. It is up to medical boards and hospitals to police their professions and staff.

          • Charlie S says:

            I was just responding to what you wrote Boreas. And while we’re at it they’ve been trying to, and succeeding I believe, in lowering the amount they have to pay if they are sued.

            • Boreas says:


              It is the malpractice insurance that ultimately pays out to a litigant – usually as a settlement so the case doesn’t go to trial. The point is, higher malpractice insurance premiums are simply passed along to consumers. If a doctor is found consistently negligent, they will eventually lose their license. In most single- payer countries, the ability to sue is much reduced. Less litigation, lower costs and fees. We can’t have it both ways.

  7. Gratified to see Bill Quinlivan’s post re the Long Lake Single Payer Town Hall and his summary of of the meeting and the key points re Single payer made by Dr. Andy Coats. Also gratified by the comments generated, many of which were quite positive and expressed interest in learning more.
    Please note that the North Country Access to Health Care Committee and the Long Lake Alliance are conducting a series of follow-up informational meetings are Single Payer at the Long Lake Public Library, 1195 Main St./Rte. 30N, with the next scheduled for Wednesday, 10/15, 6-8 PM. For further info, call Jack Carney at 518-624-4000 or e-mail him at

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