2010-09-24 / Columnists

It’s My Turn

Health Care Reform And New York: The Challenges Ahead (Part II)
By Dr. Harold Paez
This is the second part of a two-part oped piece by Dr. Paez, who is a candidate for the New York State Assembly in the November election.

We are left with a larger pool of individuals using healthcare dollars at a faster rate without any means of checking the costs of that care inherently. We are also left with thousands of overburdened healthcare professionals struggling to meet the demands of a much larger patient pool as the Healthcare Reform act makes no immediate provisions to increase the number of healthcare providers. Note that throughout the entire discussion of Healthcare Reform, never once was the “quality” of healthcare stressed. Only the expansion of it’s availability. Rather than use the actuarial models of insurance methods to maximize utility by perhaps placing the responsibility of good health on the individual (as a Health Savings Account model does) this model discounts the idea of individual responsibility at its core in favor of a government bureaucracy with “limitless” funds. The health savings account plus major medical insurance model of coverage would not only maximize the use of existing medical infrastructure, it would also discourage the overuse of finite medical resources by allowing the patient to make informed decisions on their own healthcare dollars. The remaining HSA aspects of the current healthcare industry are in fact undermined by the Healthcare Reform bill. Specifically, pre-tax monies set aside in flexible spending accounts will be significantly limited and their use restricted.

Moving on the private insurance plans, the new law gives the government much stronger powers in dictating how private healthcare policies will look. Many in New York state will begin to notice higher insurance premiums as the insurers are forced to increase premiums to comply with the mandates such as extending coverage until the age of 26 for adult children of the insured and for those with preexisting conditions who in the past were absorbed into the state’s Medicaid system. The higher premiums will begin to have the effect of thinning out private healthcare companies as they begin to compete with the government administered (lower quality/lower paying) insurance exchange offerings. When coupled with the mandate on small businesses to provide healthcare coverage for all employees or pay hefty fines, the choice will become clear to businesses: switch to the government plans or wither away on the cost of private healthcare. This will lead to jobs lost directly in the healthcare insurance industry and in the private businesses which will not be able to set up shop in New York State for fear of prohibitive medical insurance costs.

The Healthcare Reform Act has been advertised as a cost saver for the nation’s health insurance burden over the long run. This is belied by the fact that the Congressional Budget Office’s cost savings estimate was based on a 21% Medicare pay cut to doctors under the Balanced Budget Act. It should be understood that between 93 and 97% of doctors are enrolled in Medicare, the largest healthcare plan which administers healthcare benefits to those 65 and above or disabled. Medicare sets the “going rate” for doctor services by virtue of it’s immense size and influence. If the 21% doctor pay cut goes through, we are faced with the mass migration of doctors out of healthcare and into an early retirement. If the 21% pay cut is rescinded with the socalled “Doctor-Fix” bill, then the entire Healthcare Reform Act shifts into the red and becomes a net drag on our economy, in direct opposition to it’s original intended purpose to bend the cost curve down. Still, the mandates of the bill stipulate significant cost cutting to medicare reimbursements to Hospitals and other health industries, again raising the specter of jobs lost due to decreasing reimbursements. Healthcare which is a major industry in New York and New York City in particular will begin to shed jobs in large numbers as Medicare Advantage plans begin to lose healthcare dollars, as private medical offices struggle to stay afloat in the face of tighter restrictions and lower collections and the hospital based industry of doctor/ residency training which is very large in New York City begins to lose positions as a matter of course and cost cutting. Some will argue that the healthcare expansion will produce new jobs, but when we consider that those new jobs are ultimately in the government sector and paid for by tax dollars, we quickly realize the flaw in the idea that we can develop sustainable jobs growth by expanding the government on the backs of the rapidly dwindling private sector taxpayer base. This is one doctor’s opinion, but it is based on many years of experience on the front lines of healthcare in this city. Our legislators in Albany will have to be prepared for difficult choices in the near future to mitigate the costly effects of the largest expansion of government in a generation.

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