Universal health care

I’ve been reading a bit to bring myself up to speed on the health care controversy. The best book I’ve read so far is T. R. Reid’s The Healing of America (thank you, Upper Hudson Library Federation, for free access to the e-book version). I should have taken notes, but here are the major take-aways:
1. To have universal health care, a nation needs to want it. The deep rift over “Obamacare” reveals we are not there yet as a nation, even though 22,000 people a year die, and 700,000 go bankrupt, solely because of lack of health insurance in our country. Many people falsely believe that anyone can receive free care for virtually any ailment in hospital emergency rooms; even if true (which it is not), that would be terribly wasteful and less effective than appropriate care venues.

2.  In order to insure everyone, everyone needs to be insured.  The healthy and young will pay in until they become unhealthy, when the system starts to pay out; by then, new healthy insureds should keep the system in balance.

3.  Covering everyone does not mean covering everything.  There will have to be some rationing — for example, hip surgery may not be authorized for someone 90 years old who has other health problems.  The body that makes these decisions must have credibility, impartiality and transparency, or people will lose confidence in the system.

4.  Non profit payers are required to reduce overhead and eliminate the bureaucracy established for the purpose of denying coverage and claims.

5.  A central power – either a single payer or a government body that sets uniform rates for all payers – is necessary to bargain effectively with providers.  What Reid does not state explicitly is that doctors and other providers should be prepared to work for less under such a system.

Citizens of the US harbor many misconceptions about universal health care, in addition to the belief that a minimal level of care already is available to everyone:

1.  Universal health care requires “socialization” of medicine, with the government owning the facilities and employing the providers. While government ownership is one model, other countries that provide superior care to all their citizens for less cost than we do use private doctors and facilities, and give citizens broad choice of provider and (non-profit) insurer.  

2.  Government cannot run health care as well as the for-profit private sector.  Medicare is one of the largest, most popular and most efficient government programs, and its administrative overhead is far lower than our private health care sector, though it serves a higher need population.  Our system of veterans hospitals is an example of pure socialized medicine, where the government employs the providers and owns the facilities, and where consumers are not billed for the services they receive.

There are many ways to skin the cat, if we have the collective will to extend health care to everyone and resist the special interests in favor of the status quo.  Obamacare may not be the ideal solution, but it’s a step in the right direction, and long over due.

Can NYRA ever be profitable?

A recent story in the Times-Union about an open NYRA board meeting shed some light on the Association’s finances, and showed that the board may be recognizing two things you read about here first:  that the VLT revenues cannot be counted upon to balance the books and that Aqueduct may have to be closed.  While this realism is refreshing, it begs the question whether a NYRA without VLT revenues can ever be profitable, with or without Aqueduct.  Among the questions I think the board needs to answer, if it can:  Is horse racing standing alone profitable anywhere?  If so, what are the owners of the profitable venues doing that NYRA isn’t?  Are there any differences in the regulatory or tax structures that could explain the difference?

Even with the changes I’ve proposed to racing — reducing the takeout, better customer service and amenities, shorter meets of higher quality, etc. — it may be that the public’s tastes have changed and that nothing can be done to make thoroughbred racing profitable in New York.  If that is so, does the State pull the plug, putting many people out of work, or does it find a way to subsidize a losing operation?

If history is a guide, New York will try to prop up NYRA and keep racing going at a loss.  If the constitutional amendment permitting casino gambling passes, NYRA and the other horse racing venues in the State will no doubt seek casino licenses, as they sought the VLT franchises, in the hope that casino winnings will offset racing losses.  If that transpires, I predict the VLT cycle will be repeated, and eventually the casino profits will either be diverted to other State purposes or they will dry up because of over saturation of the market.

Far preferable, in my view, would be an ultimatum:  run at a profit (unsubsidized by other gambling revenues) within five years or be gone.  To meet that goal, you might see Aqueduct and even Belmont close; Saratoga probably would survive, though any significant lengthening of the Spa season would hurt that venue.