It’s an idea whose time has come. In fact it’s an idea whose time came a long, long time ago across much of the western world.
That idea is single-payer healthcare: a system that provides universal, free-at-the-point-of-need care where the government picks up the tab. Every major country on earth has it, except for the US. However, all that may be about to change – starting with New York.
The New York Health Act would establish a comprehensive, single-payer healthcare system in the state of New York, eliminating the hodgepodge of private insurance, Medicare, and Medicaid programs that currently exists. Medical, dental, vision, hearing, reproductive, and mental services would all be provided to all New Yorkers, regardless of their health, wealth, or evidence of a pre-existing condition.
If this sounds fanciful, remember that this system already exists in some form or other in Canada, the UK, France, Germany, and Japan to name just a few. Alternatively, if you think it sounds great but could never happen here, keep in mind that the Act passed the New York state assembly on May 16 and is a single vote away from gaining majority support in the state senate.
With single-payer healthcare within touching distance, progressives have hit the streets in a bid to pressure the senate to pass the bill and send it to the Governor’s desk before the legislative session ends on June 21.
At the forefront is Get Organized BK, a grassroots activist group committed to fighting the injustices of the Trump administration and championing progressive causes.
“Healthcare is truly a nonpartisan issue for the people of New York,” says Morgan Moore, a member of Get Organized BK’s New York state healthcare working group. “We all need it and this Act offers a more sensible, equitable, and less costly way – in terms of both lives and money – to provide it. We’ve collected hundreds and hundreds of signatures from all across Brooklyn, from people of every demographic. The public support for this bill is there, we just need to give people the information and tools they need to contact their legislators and make their voices heard,” she adds.
This brand of local activism may hold the key to the Act’s success, as the biggest obstacle frustrating its passage in Albany is Simcha Felder – a Brooklyn state senator elected as a Democrat but who caucuses with the Republican majority. If Felder signalled his support, then the Act will have its majority. Yet Felder has stayed maddeningly silent on the issue, and gone to extraordinary lengths to avoid press inquiries as to his position.
Get Organized BK is betting everything on its grassroots campaign to get Felder off the fence. The group is also lobbying Republican state senators, not one of whom have put their names against the bill as of yet.
“We are doing endorsement drives all over Brooklyn, but focusing on the districts of Senators Simcha Felder and Martin Golden [a Republican], who do not currently support the bill. We’re also working on getting endorsements from small businesses, because the bill would make administering employee health benefits easier and more affordable. And we’re trying to put particular pressure on the Republican members of the Senate Health Committee, where the bill is currently held up,” says Adam Schneit, another member of Get Organized BK’s healthcare working group.
Opposition from the GOP and the right-wing media focuses on the plan’s costs. They claim single-payer would bury the New York economy under a mountain of tax rises and explode the state budget to boot.
What are the facts? First of all, yes, single-payer would require an increase in state taxation – though the savings made possible under the system would mean that 98% of New York households would spend less on healthcare than they do now. That’s according to an economic analysis of the bill conducted by Gerald Friedman, an economist at UMass Amherst.
Under the New York Health Act, single-payer would be funded by a progressive, income-based payroll deduction and a similarly gradated levy on non-payroll income: such as capital gains and dividends. Those with the broadest shoulders would carry the greatest burden.
Businesses could also realize savings under the plan. “New York Health would make administering employee health benefits more efficient, predictable, and more affordable, and would end reliance on property taxes to fund Medicaid, so we’ve had a lot of intense interest from the business community. In talking with them, we have found that many small business owners do not have health insurance for themselves, let alone their employees, because they cannot afford it under the current system. This bill would, for the first time, give them access to the healthcare they need. That’s not just good for that one person or one business, that benefits the community and our entire economy,” says Moore.
A wealth of savings would also be had through the elimination of bureaucracy and administration costs associated with the current tangle of public and private insurance schemes. Amherst’s Friedman estimates that around $26.5 billion would be saved by abolishing private health insurance administration, $20.7 billion by reducing health care provider administration of health insurance claims, $2 billion by eliminating employer administration of health benefits, $5.4 billion by reducing fraudulent billing, and $16.3 billion by capturing savings from overpriced drugs and medical devices – for a total of over $70 billion, or 25% of New York’s projected healthcare spending in 2019.
Yes, these figures are contested by single-payer’s opponents. No, it’s not possible to determine the eventual costs of a single-payer system to the last cent. Yet it is true that countries that have adopted single-payer systems pay less for healthcare as a proportion of Gross Domestic Product (GDP) than the US. As of 2014, the United States sunk 17.1% of GDP into healthcare; in single-payer Canada, the figure was 10.4%; in the UK, 9.1%.
At its core, though, the argument for single-payer does not rest on a sterile calculus of nickels-and-dimes. It hinges instead on a society’s collective agreement that healthcare is a right, not a privilege, and should be extended to all citizens regardless of their wealth, status, or need.
New York, at least, seems achingly close to coming to that agreement.