By Elizabeth R. Rosenthal, MD & Leonard Rodberg, PhD | June 5, 2021

We are happy for George Knauer’s feeling of security with his Medicare Advantage Plan. But not so are many seniors in these plans who experience a serious accident or illness. Then they discover that care is harder to come by if specialists or special hospitals like New York City’s Memorial Sloan Kettering Hospital and Hospital for Special Surgery are required. And with multiple doctor visits every month, the co-pays can really add up. The requirements for prior authorizations can delay needed care.

These things occur because private Advantage Plans are not in the business of providing care but making a profit. One makes a profit as a health insurance company by NOT delivering care while still collecting premiums. This is what happened during the current pandemic. The companies raked in record-breaking profits while the patients they insured often went without care and suffered and died.

If we do nothing to change the status quo, total health expenditures in New York are projected to total $352B in 2025. Under the NY Health Act, after covering all NYS residents with no premiums, copays or deductibles and expanded benefits (e.g. long-term care, vision, dental and hearing services), total expenditures for 2025 are projected to be $336B, or $16B less than the status quo.

The choice of provider would be much greater with the NY Health Act as almost every doctor would participate. With Medicare Advantage, choice is restricted to a narrow list of providers which can be changed at any time by the private insurance company. Corporate executives, not politicians, decide what treatments are necessary in Medicare Advantage with a view to their bottom line.

As for choice of plan, the only reason to have more than one plan is that you cannot afford the good one. With the NY Health Act, you would get the good one simply by being a resident of New York or working in New York. And there is no evidence that quality of care would be less nor wait times longer with the NY Health Act. If you traveled elsewhere and needed care, you would still have your Medicare card, and NY Health would cover what it didn’t pay for.

In short, the NY Health Act would not take away your Medicare but would give you and all New Yorkers an improved and expanded access to care guaranteed for life while saving NY state billions.

Elizabeth R. Rosenthal, MD and Leonard Rodberg, PhD, Physicians for a National Health Program – NY Metro Chapter.


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