Shining Ithaca

Tim Joseph, chair of the Tompkins County Legislature, writes in the Ithaca Journal that a single-payer system would benefit Tompkins County.

The Pueblo County Commissioners said the same thing earlier this year when they offered testimony to the Colorado Blue Ribbon Commission for Health Care Reform.

The benefits of a single-payer system used to be a topic upon which reasonable, informed people could disagree, but that is no longer the case. At this point it's a no brainer that single-payer is the way to go.

Joseph gives a long list of cost savings from single-payer that aren't usually included in modeling or discussions:

* Our county, like every county, has an Office for the Aging. We have a 10-person staff, and the largest part of their work consists of helping seniors to navigate the health care system, find the programs that are available to help them and plan how they will manage health care costs now and in the future.

* We have a full-time benefits manager who is mostly occupied with assisting employees in dealing with the health insurance program. Those employees also lose productive work time consulting with the benefits manager and fighting insurance company denials, which can take hours from the workday.

* When we negotiate with our employee unions, health care is always the biggest topic. We have a health care consultant on retainer to help us examine and cost out plan changes that we present to our unions in an attempt to control costs. At least two-thirds of the staff time devoted to collective bargaining is spent on health care issues.

* We devoted hundreds of hours of staff time to developing and publicizing a discount prescription drug card available to all county residents to reduce drug costs for those without insurance.

* We have a $400,000 grant from the state to form a health insurance consortium among local governments so that we can purchase employee health care as a larger group. We will be hiring a consultant to help us through the process of forming that consortium and then finding a suitable plan. Various county staffers are devoting substantial time to moving this project forward.

* We have staff in our Mental Health Department, Public Health Department and Department of Social Services devoted to collecting fees from private insurers to reduce the public cost of programs that deliver various health services.

* We have people waiting in jail that judges are prepared to release to drug or alcohol treatment programs as soon as we can assure payment to the treatment center. Staff in local agencies and our Department of Social Services work on getting these inmates into health care programs, mainly Medicaid, that will cover treatment. Meantime, we pay the cost of incarceration.

* Our economic development staff encounters aspiring entrepreneurs who would like to start their own business but are tied to a job by the health insurance benefits. Young businesses that do get started often have trouble attracting the employees they need because they cannot yet offer a health plan.

Joseph evidently recently testified before a task force put together by Gov. Eliot Spitzer examining universal health care.

Good luck to them.

One way to pay for single-payer

The McKinsey Report suggests that savings would be greater than this pie chart shows.

In Ohio, they're proposing a payroll tax increase — but only by eliminating the $90,000 cap. They'd collect it on all payroll income, plus a 5 percent surcharge on income earned beyond $200,000.

They would also have an employer tax of up to 3 percent and an income tax increase of up to 3 percent — depending on what costs actually were. Because despite all the modeling, we don't know how much we'd save by eliminating the gross inefficiencies of our current system. It might be just 1 percent in both catagories.

I've seen another model recently that showed that if a person made more than $200,000 a year they'd pay more for healthcare under that single-payer system. Everyone else would pay less.

Which would you prefer: People who earn $250,000 a year paying perhaps $4,000 more annually for healthcare, or people dying because they can't afford it at all?