New York City Jumps on Healthcare-for-All Train

Mayor Bill de Blasio announced yesterday that he wants to spend $100 million to provide healthcare “coverage” for an estimated 600,000 uninsured New Yorkers, and that includes an estimated 300,000 undocumented individuals. Predictably, in absorbing the comments from New York Times readers, de Blasio's position falls along the same political lines and mouths the same political ideology. That's really good for this plan because it will help provide the necessary smoke and mirrors. It is not that the proposal is a version of “fake news.” Rather, it's that neither side actually looked at what is being proposed; they just went directly to their favorite meme.

“Everyone is guaranteed the right to health care, everyone.”

-- Mayor Bill de Blasio

Now, a point of fact: Anyone can obtain care at any hospital in the city's Health and Hospital Corporation's (HHC) municipal system. But most often this care is provided in the Emergency Department, not in the offices of primary care providers. There are many reasons for that beyond an inability to pay, including lack of access, and convenience, because waiting all day to see a doctor is problematic for everyone. The Mayor acknowledged that problem and indicated that some funding would go to creating a hotline, presumably for referrals to primary care providers and a membership card. How the $100 million is to be spent is unstated and unclear. The only thing we really know is the dollar amount. 

HHC's current financial health is also somewhat fuzzy. The Times is reporting a $156 million shortfall in 2018, citing the city’s budget office, and “a very cash-strong position,” according to the city’s budget director. It does not fill me with confidence when the office and its director come to two very different conclusions, especially when talking about money. 

Several of the Times' readers commented upon how much care could actually be given to these individuals. After all, the average available is about $166. When I looked at the 2018 fee schedule for physicians and nurse practitioners, that amount would cover two visits, maybe three. So that's not really a lot of care when you're ill. 

Separately, the Mayor has a similar project involving the distribution of free transit cards for those living below federal poverty guidelines. That bill will be about double, and it's just being rolled out. As the Times reports, 4% of the estimated 800,000 eligibles will be getting those discounted cards now. And like this program, the additional medical care will be rolled out over time –– estimated implementation is two years –– and we all know that it will be a slow roll, indeed. 

To understand what is really going on you must consider politics and the money. The Mayor is presenting his “progressive” bona fides, just as California's newly-elected Governor, Gavin Newsome, is doing and San Francisco’s municipal leadership has done for years. (Parenthetically, here's an article from Vox on a recent visit by an insured patient for a broken arm –– she was balanced-billed $20,000, to help defray the cost of care for those without insurance.)

As to the program's cost, the “follow the money” directive still applies. The $100 million is coming from the city’s pocket and being transferred to another one of its pockets. The real cost, as always, is putting the money in the city’s pocket to begin with. And you know the only real source of those funds: you and me.

Everyone should be able to get healthcare. But grand pronouncements and political posturing by both sides does not get the job done. Sadly to say, it's easier for everyone involved to take a position and not have to make tough choices about how to apportion a limited resource. The pronouncement by Mayor de Blasio bolsters his base, riles the opposition and further hampers a meaningful discussion to find ways for everyone to receive care equitably.

Source: New York Times De Blasio Unveils Health Care Plan for Undocumented and Low-Income New Yorkers