Slow road to reforming health care


Dr. Phil Schneider likes to keep it simple.

Walking into the speech pathologist’s Whitehall clinic, patients generally don’t find much more than a small sparsely decorated waiting area, leading to an office dominated by Schneider’s desk, with a big window facing Independence Avenue.

Despite running a number of similar offices throughout the city — and even a pair in Israel — Schneider runs his practice without the standard office staff one might expect. Because of that, Schneider tends to deal with all his own paperwork, most of which deals directly with health insurance companies.

Receiving standard health care can be challenging enough through such insurance. When it comes to specialists like Schneider, it’s an everyday uphill battle that eats more and more of his time.

Some patients arrive only to learn their insurance doesn’t cover the speech services Schneider provides. It’s good news for those who do have coverage — until it’s time to deal with the fine print.

“I come up with a diagnosis,” Schneider said, promptly sending a claim off to the insurance company. He’s almost immediately told an expert has reviewed the claim, and the treatment a patient is seeking is not authorized.

“There is no expert,” the doctor said. “No one has seen the claim. It’s standard procedure to reject claims.”


Time not spent with patients

Such rejections prompt what will likely be hours of Schneider’s time writing letters to insurers, pushing for authorization to treat a number of maladies, like stuttering, which makes up 70 percent of his practice.

“That causes a great deal of suffering,” Schneider said. “These companies say it’s a psychological issue, but it has been proven for years that that is not the case.”

And it can be a losing battle for Schneider, who already loses valuable time seeing patients because of the time needed to deal with insurance. Larger doctor offices —and especially hospitals — dedicate full departments to nothing but insurance bureaucracy. In fact, a 2003 study in the New England Journal of Medicine found one-third of all medical expenses were created from administrative tasks like paperwork, billing and processing.

Health care reform has been a hot topic in the United States for decades, with efforts at both the state and federal level to curb what costs the typical person more than $10,000 per year, according to government research.

A decade ago, Congress passed the Affordable Care Act, designed to get every American insured for health coverage. But there are still many policies patients will claim are not worth the paper they’re printed on.

And with major insurance companies keeping a firm hold on Washington, efforts to change health care has returned to the state level with efforts like the New York Health Act closer to reality today than it ever has been before.

In fact, the act that would essentially create government-sponsored single-payer health care was a primary platform plank in the campaign to end Republican control of the state senate. But more than a year after the destruction of Sen. Jeffrey Klein’s Independent Democratic Conference that allowed Republicans to hold onto that power, getting the New York Health Act passed has moved at a snail’s pace.

“It’s a fact that being sick is miserable enough,” said Barbara Estrin, a local proponent of the New York Health Act. “But then to have to worry about how you’re going to pay for it? That’s nonsense.”

Estrin moved to Riverdale a decade ago, after spending decades as a Shakespearean professor in Rhode Island. She has pretty solid insurance, so health care wasn’t much on Estrin’s mind until she attended a rally at the Riverdale Monument ahead of Donald Trump’s 2017 inauguration, and she heard Eric Dinowitz — son of Assemblyman Jeffrey Dinowitz — talk about the New York Health Act.

“I hadn’t heard of it before that,” Estrin said. “So I learned more about it, and I loved what I learned. It’s the only single-payer plan that has all the economics worked out. And no one writes about it.”


Who foots the bill?

But how to actually pay for it is still up in the air. In the most recent bill that cleared an Assembly committee in February, legislative analysis determined federal funds and existing Medicaid at the local and state level would finance such a bill, as would “revenue measures to be proposed by the governor.” Those measures could include payroll taxes, and even a wealth tax.

Those are significant speed bumps slowing down the bill, said state Sen. Alessandra Biaggi, who campaigned in support of the New York Health Act. On top of that, a statewide single-payer system also would depend on a federal Medicare and Medicaid waiver — something not likely to come from a Trump White House.

“You want to do it right, and not sloppy,” Biaggi said. “If we’re going to do this, we can’t fail. It would just provide ammunition to the arguments on why this program doesn’t work, so we have to do it right.”

No one knows that better than Assemblyman Richard Gottfried. The Manhattan Democrat has sponsored the New York Health Act every year since 1992. While the basic concept of the bill has remained the same — provide health care to every person in the state — the structure and funding model have been refined over time.

“I believe that virtually every problem that we have in health care — whether it’s as patients, or as health care providers, or employers or taxpayers — is made worse and harder to solve because of our current system of paying or not paying for health care,” Gottfried said. “So that’s what drives me.”

Although an “awful lot of New Yorkers enthusiastically support” the New York Health Act, Gottfried admits there is a lot of opposition, too. And not just from Republicans. Some unions and the broader business community as a whole are against it, fearing the costs will bankrupt the state. And the insurance industry, of course.

In fact, the New York State Association of Health Underwriters — which represents insurance companies — blame increasing medical costs, not its members, for the unaffordability of health care.

But there are some major unions for the New York Health Act, Gottfried said, because it would allow them to focus on other issues than just health care in collective bargaining agreements.

“They understand that trying to defend the union health plan in every bargaining round is harder and harder to do,” Gottfried said. “That makes it almost impossible to negotiate for wages and other benefits because all their effort is put into trying to protect the health plan.”

In the meantime, Phil Schneider will continue to try his best to provide funded speech therapy to his patients.

“I believe in people getting good medical care,” he said. “I hope and pray that we get to a point where people can get access. It’s a very unfair system, where those of us with more in the pocket get more.”

Dr. Phil Schneider, single-payer health care, State Sen. Alessandra Biaggi, Affordable Care Act, New York Health Act, Assemblyman Richard Gottfried, Kirstyn Brendlen, Michael Hinman, Heather J. Smith