Eliot Spitzer has just graduated from fighting corporate crooks on Wall Street to fighting the entire New York health insurance industry. He’s just unveiled his new health care plan, which centers on expanding Medicare coverage while at the same time slashing funding to hospitals that waste money.
Spitzer promised reforms aimed at cutting spending while improving care and insuring hundreds of thousands more New Yorkers. He said he would freeze Medicaid funding to hospitals and nursing homes where it is wasted, but won’t cut benefits to individuals. He also promised to use some of the billions of dollars in savings he targeted as waste and fraud to cover more uninsured New Yorkers and to improve all health care.
Needless to say, health care providers are incensed.
“These are many of the same budget cuts that Governor Pataki proposed, and they were rejected because, frankly, they aren’t reforms,” said Daniel Sisto, the president of the Healthcare Association of New York State.
“By his tone today, he intends to make it a serious fight,” he said. “The Legislature knows that these cuts, now two decades old, do not constitute reform. I’m working on the assumption we can persuade them to reject them.”
You can get the details of Spitzer’s proposal straight from the horse’s mouth. His proposal’s immediate goal isn’t universal insurance, but only universal insurance of children and cutting New York’s rate of uninsured people by half.
However, many of the planks he supports to reduce wasteful spending are the same ones that cause countries with single payer systems to spend so much less than the US. New York’s state spending on Medicaid, $2,200, is on a par with the cost of universal public insurance systems such as those of Japan, Britain, Canada, and France.
Spitzer’s eight point proposal is,
1. Stopping funding phantom medical residents, who don’t exist but still receive state money;
2. Subsidizing private insurers less, by calculating need based on the state’s calculations rather than what the providers say they need;
3. Extending Medicare Part D to Medicaid, and shifting coverage to cheaper drugs when several equivalent alternatives are available;
4. Coordinating care for patients who suffer from multiple diseases;
5. Expanding managed care;
6. Computerizing health records;
7. Cracking down on Medicaid fraud;
8. Focusing on primary and preventive care.
Points 4, 5, 6, and 8 are important reasons public systems cost so much less than what the US has. American administrative costs are sky-high partly because absent state regulations, hospitals can’t computerize health records or coordinate care, leading to more bureaucratic red tape than is necessary. The lack of universality of insurance, which requires hospitals to ensure that patients have insurance, is only part of the problem.
In addition, the lack of universal insurance has caused American health care to underemphasize preventive care. Points 5 and 8 are intended to work around the problem given the fact that there’s a private insurance industry that’s running public health into the ground.
In the interest of fairness, I should note that some of Spitzer’s goals are too ambitious. He mentions obesity as one reason to focus on primary care; but Canada and Britain, which have universal insurance, have almost the same obesity rate as the US. Obesity rates track poverty and eating culture more than they do the strength of the public health system.
Still, given that the total level of health spending on an American is higher than this on a Canadian and a Brit combined, despite the almost equally unhealthy personal habits, it’s likely reforms of the type Spitzer is proposing will help.
A full reform of American health care will likely have two components – one focusing on insurance, as in Wyden’s proposal, and one focusing on administration and costs, as in Spitzer’s. Combining the two into one is good for some rhetorical tricks, like “Our public health care spending is the third highest in the world, and we still can’t cover everyone,” but not necessarily for making the reform easier to pass.
On a completely different note, Spitzer’s speech is a joy to read if only because it gives more specifics than anything else by a politician that I can remember. If Obama or Edwards or Clinton were this frank, I’d be a lot more supportive.
Unfortunately, none of the three has much to gain from having Spitzer as a running mate. Clinton is from the same state, and Edwards and Obama have similar domestic focuses. It’s too bad; Spitzer’s just joined the club of people I’d be really enthusiastic about if they ran in the Democratic primary, instead of the three lullaby singers who have a shot at winning.