NY Senate Bill S5474 proposing a universal single payer health plan for NYers

Why do you ask?

Yes, exactly. Reckless drivers and reckless homeowners should pay higher premiums, as their insurance covers a higher risk (a priori expected cost) compared to responsible drivers and responsible homeowners.

> The whole idea of insurance is to distribute the costs so that no one has to bear long tail costs alone...

The "whole idea of insurance" from the buyer's perspective is to pay a fixed premium instead of carrying risk. The value of the service, and thus the premium one is willing to pay, is determined by the risk being mitigated for each individual customer. The existence of "risk pools" is important for the insurance provider's cash flow, but a mere implementation detail to the customer. Insurance is not a subsidy or charity; if you and others like yourself are expected to cost more on average than some other group, you should expect to pay more. In a competitive insurance market those with higher risks will pay higher premiums; a company that attempted to charge everyone a flat rate would find itself either bankrupt or incapable of competing on premiums for any but the most expensive (highest-risk) customers.

It was far cheaper for me than it would have been as a Brit in the USA, but the standard of care was lower. They didn’t have some technical and staffing resources late in the afternoon that would be a baseline in any of the hospitals I’ve been at in the USA. The English doctors were just kind of apologetic and bashful about it, talking to someone they knew was an American doctor who knew what kind of specific diagnostic algorithm was appropriate.

The NHS hospital did have really excellent amounts of ancillary staff. Someone brought coffee and tea to me like 3-4 times a day, it wasn’t hard to get my luggage delivered to my bed, etc. Not like that in the USA from what I’ve seen.

The NYC hospitals are somewhat financially strained as it is. Especially the public hospitals (Bellevue, Elmhurst, Metropolitan).

Also related would be care at the VA hospitals, which is slower/worse than care at NYC flagship hospitals. But as a society we don’t want to prioritize or pay for good care for veterans, so it is what it is.

I predict this will continue to basically just produce a more two-tiered system in the US. Most doctors who have a choice (large group practices) will take the wealthy patients with private insurance, and the big hospitals and whomever else who don’t have a choice will be forced to accept the NY single payers (basically the existing model, where the poor and 65+ are already covered under Medicaid and Medicare already). It will likely strain these systems even further, as reimbursements from Medicaid/Medicaid are insufficient to run large health systems which depend on higher rates from private insurers (payor mix). Good luck there.

In NYC even more physicians and group practices will try to go to alternate models such as cash-only. Try being on Medicaid or Medicare and finding an outpatient psychiatrist in NYC now as it is. This will extend to more PCPs, chronic disease specialists, etc.

Some patients will get better and more affordable care, but some will also get much worse care. It will be interesting to see what happens. I’m not necessarily opposed, but this is absolutely not going to be a clear and decisive win on all fronts as some commenters are suggesting. The US healthcare system, if you have private insurance, is the best in the world already in terms of level of service and access to rapid specialty and high-end care.

There’s really no way to increase taxes without impacting consumers. Unless you try to limit rents, but then you have other problems with people not wanting to invest in apartment buildings.

I think a country which lets some get rich off of other’s cancer is an abhorrent, indefensible, system.