Can single-payer health care work in NY?

Feb. 17--Democratic state lawmakers have passed a stream of pent-up priorities this year since winning full control in Albany, enacting election reforms, new gun-control measures and other bills Republicans had blocked when they ruled the Senate.

But the question now is whether a Democratic-controlled Legislature and a Democratic governor will tackle the oldest and most ambitious of those once-impossible plans: a single-payer health insurance system akin to what is championed in Washington as "Medicare for all."

The New York Health Act, first introduced in 1992 and approved by the Assembly each of the last four years, is back before the Legislature with a few additions in the version filed this month. Its mission is state-run, comprehensive coverage for every New Yorker that would eliminate private insurance and be paid for with new taxes and the public funding that New York now spends on Medicaid and Medicare.

For supporters like Star Hesse of Sullivan County, who has made annual trips to Albany to rally for the bill and believes it now stands its best chance of becoming law, the key is removing profit-minded insurance companies from the system. She argues the state could cover everyone and yet reduce total health-care spending, partly by chopping the part that now goes to company shareholders and executives.

"To them, it's a business," said Hesse, a Narrowsburg resident who's active with the Campaign for New York Health advocacy group. "To other people, it's life and death."

She answers the charge that New York couldn't afford single-payer health care by arguing that the current insurance system is both too expensive and inadequate.

"We can't afford what we have now -- and it's crappy coverage!" Hesse said.

Opponents question why the state should scrap the insurance most New Yorkers get through their jobs to help a shrinking pool of the uninsured, and argue the new taxes for a single-payer system would drive more residents and businesses from an already costly state.

"If you see an exodus now, you're going to to see a massive exodus if this goes through," said Assemblyman Karl Brabenec, a Deerpark Republican who has voted against the New York Health Act each time it has come up. "Anybody who supports this kind of thing should get their head examined."

Brabenec also argued the shift from private to public insurance would drive up costs, not reduce them, and multiply the sort of bureaucratic headaches that his staff helps constituents resolve with various state agencies.

Gov. Andrew Cuomo has dashed cold water on the proposal, which raises the possibility he would veto the bill -- and anger progressives in his party -- if both the Senate and Assembly were to pass it. As an alternative, he has proposed setting up a panel of experts to recommend ways to improve private insurance and expand public programs to cover the remaining 5 percent of New Yorkers who are uninsured.

"Single-payer in theory makes sense; in practice I don't see how you do it without doing it on a federal level," Cuomo said when asked about the proposal during a press conference last week. "States have tried to do it on their own. They've all failed."

A major obstacle if the proposal became law would be the need for the federal government to grant waivers for New York to spend Medicaid and Medicare dollars on a single-payer plan. The Trump administration wouldn't grant those waivers, which means the New York Health Act probably couldn't be implemented for at least two years. (Supporters argue that's no reason not to pass the law, since it would take the state several years to develop the regulations for the program.)

The bill would impose two new taxes: a payroll tax that employers and workers would split, 80 percent to 20 percent; and a tax on other income forms such as stock dividends. For New Yorkers with private insurance and businesses that provide it, the payroll taxes would take the place of the premiums and out-of-pocket medical expenses -- deductibles and co-payments -- they now pay.

Among the bill's advocates is Dr. Paul Salzberg, president of the Sullivan County Medical Society and a board member for New York State Academy of Family Physicians. Salzberg, who practices in a medically underserved area in western Sullivan, says single-payer health care would particularly help his patients who either have no insurance or are underinsured, meaning they must pay too much for care or travel too far for in-network specialists under their plans.

He said the Sullivan County Medical Society and state Academy of Family Physicians both have declared support for the New York Health Act.

"Most civilized countries have this system, and it's important to have it here in New York," Salzberg said of single-payer care.

Opponents include the state chapter of the National Federation of Independent Businesses, which described the proposal last week as "an immense cost burden" that would make New York's small businesses less competitive.

"We are already one of the most business-unfriendly states," Seth Arluck, owner of New Hampton Lumber and a member of the state NFIB's leadership council, said by email, listing the high taxes and other expenses that businesses must shoulder and calling a single-payer payroll tax "another economic body slam."

He and his brother don't buy health insurance for themselves or their small staff, so the single-payer payroll tax would be a new expense, not a replacement for premiums. Arluck said enactment of the New York Health Act might be the final straw that causes him to move his business to Pennsylvania.

State Sen. Jen Metzger, a Rosendale Democrat who took office in January, supported the bill during her campaign and makes similar arguments today, saying that rising medical and insurance costs are a pervasive problem that drives up property taxes and burden businesses while leaving people without services or medication they need.

"Health care costs in New York are among the highest," she said. "Many people cannot afford it. We should not be in that position in a modern society. People should have access to the health care they need."

She said residents of the 42nd Senate District, which includes all of Sullivan County and parts of Orange and Ulster, felt the same way when she knocked on their doors last fall. "Universally, people felt we needed to do something to change the way we do health care in New York," she said.

Metzger said she's open to other approaches to lowering costs and expanding access to care. Until then, she said, the New York Health Act is "the best alternative I've seen to date."

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