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Like hospitals, insurance system is also in crisis

Tuesday, prominent community leaders in Buffalo will hold a public hearing on the Berger Commission's proposals to close hospitals as a way to reduce health care spending. The hearing will help sort out what savings are realistic, and at what cost to workers, patients and communities. More important still, the hearing, organized by the Coalition for Economic Justice, will focus attention on solutions to the broader health care crisis.

The current insurance system just isn't working. There are 2.8 million New Yorkers who don't have insurance. For people who do have insurance, health care is too expensive; no item in the family budget is rising faster.

As important as the effect on families, though, is the effect on economic growth. The convoluted way we finance health care is one of our nation's biggest job-killers. Responsible companies that pay for health care are being crushed by the rising cost of insurance.

The best solution would be a national single-payer plan. But if Washington doesn't move, New York should look into a state-based single-payer system.

Virtually all of the world's advanced economies have universal coverage. There are models that integrate choice of doctor, private insurance on top of the basic government plan and the ability to pay to skip ahead of a queue.

Can we afford it? The United States spends about 16 percent of gross domestic product on health care. Compare that with 7.7 percent in the United Kingdom, 7.9 percent in Japan and 9.9 percent in Canada. Universal insurance is much less expensive.

It's encouraging to see states like Massachusetts and California moving forward on universal coverage. But their models cost billions more, while a single-payer system would cost billions less than current spending. According to one estimate, cutting out administrative costs would allow a single-payer system in New York to reduce spending by 19 percent, a savings of $23 billion.

Short of a single-payer plan, there are other sensible ways New York can improve coverage. Bulk purchasing of prescription drugs on behalf of government programs, the uninsured and private groups would help lower one of the most problematic health care costs.
In addition, current law forces businesses that provide insurance to pay a surcharge that helps pay for emergency room visits by uninsured people. Employers who pay for coverage wind up subsidizing employers that don't. It would be better to reverse that situation, or to pay for uncompensated care out of the state's general revenues.

Gov. Eliot Spitzer has proposed to guarantee access to health insurance for all uninsured children in the state, and to get all adults who are eligible for Medicaid actually enrolled. At Tuesday's hearing, local residents, workers and policy experts can push the state to take those first steps, and then to push even further.

David Dyssegaard Kallick is senior fellow at the Fiscal Policy Institute. The hearing is at 6:30 p.m. Tuesday in Trinity Episcopal Church on Delaware Avenue.

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