I – Present Status: The New York Health Act, or single payer health bill, would seem to be a “no-brainer”, offering something beneficial for all health care stakeholders in the State: universal health coverage for all New York residents; and large projected cost savings for employers, for small and large business owners, for State and county governments, and for all those insured under the New York plan. Yet its passage in the legislature and enactment into law are no sure things. It was first introduced in the Assembly by its long-term sponsor, Richard Gottfried, in 1992; gestated for twenty-three years in its Health Committee until 2015, when it was first passed; made it through the Assembly again last year; and now, in 2017, has a good chance of passage by the Assembly and making it to the floor of the State Senate, but currently languishes in the Senate’s Health Committee.
Accordingly, be forewarned that the principal features of the Act I describe below are likely to undergo dramatic change before it’s enacted into law. It’s clear who the principal beneficiaries will be — working people who earn less than $100,000; those who are poor enough to qualify for Medicaid and families with disabled children eligible for CHIP (Children’s Health Insurance Program); and retirees, particularly those who receive Medicare. Yet many questions remain unanswered. What about the self-employed? Will small businesses, particularly those that are seasonal and cater to Summer tourists, be able to afford to provide their employees with New York Health coverage? While it appears county governments statewide will realize great savings, how much will actually accrue to small town and village governments that provide health insurance to their employees?
How to persuade the many other stakeholders – the health insurance companies; Big Pharma; Big Hospitals, particularly the prestigious teaching hospitals in New York and Albany that employ highly paid, equally prestigious medical specialists; and conservative politicians – to support Single Payer? How to persuade those of us who stand to benefit most, the ordinary residents of the State, to advocate unrelentingly for its enactment into law?
There will be a lot of lobbying undertaken by the large organizations that will be affected, a lot of give and take between them and our legislators. Since we, advocates and New Yorkers, might well hold the balance of power here, we must work hard, organize well, and make sure that we’re in the thick of it.
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II – The Bill: The companion single payer bills introduced by Assemblyman Gottfried (A. 4738) and Senator Rivera (S.4840) call for the establishment of New York Health and the provision of universal health care coverage for all New York residents. The cost per individual and per family will be based on ability to pay, with each assessed a graduated tax on all income, earned and unearned. According to the economic analysis completed by Gerald Friedman, UMass, Amherst, in 2015, the burden will fall less heavily on households with annual incomes below $75,000. In addition, there will be no deductibles and no co-payments charged for services received.
To illustrate, employed individuals who receive health benefits through their employment will pay 20% of the earned income or payroll assessment and their employers will pay 80%. Persons earning $75,000 a year, will pay a NY Health assessment of $1000 and their employers’ $4000, with savings to each of $1403 and $865, respectively, when compared to the current cost of employer-provided health insurance. Families with annual incomes of $75,000, as per Friedman’s estimate, and employer-provided health insurance, will save $5,505 and $9,298, respectively. It is not clear at present whether self-employed individuals earning $75,000 per annum will incur similar costs and realize similar savings.
Individuals and families eligible for Medicaid, Medicare, Family Health and Child Health Plus will receive augmented coverage through New York Health. The monies received from the Federal government for the beneficiaries of those programs, together with the NY Health tax assessments, will be folded into what the bill terms the New York Trust Fund, which will assume responsibility to pay all health costs incurred. The Fund will also pay the Medicare Part B premiums for those Medicare recipients who have that coverage. Since New York Heath will provide complete coverage, supplemental insurance to pay the 20% Medicare deductible and to cover dental expenses and Medicare Part D’s “donut hole” will no longer be needed. Medical benefits received as part of individuals’ retirement packages might also be folded into the Trust Fund.
Friedman’s 2015 analysis predicts a reduction in health care spending by 15% or $45 billion annually by 2019 – in short, a dramatic reduction within four years of enactment. The key feature of the Health Act is that it puts private health insurers out of business in the State, eliminating the cost of their overhead and profit. Savings will also accrue from the reduced cost of employer administration of employee health benefits; of physician and hospital billing expenses; and the reduced cost of prescribed drugs and medical devices. Further, New York’s counties will no longer be obliged to contribute to the State’s Medicaid costs, resulting in savings for all upstate counties amounting to more than $1.3 billion or over 46% of the $3 billion in property taxes collected annually. New York City will accrue savings of nearly $8 billion dollars or 30% of the $21 billion in property taxes levied annually. This windfall can be used by each county to reduce property taxes or pay for county-wide services and improvements.
A caveat. Most pre-law cost and savings estimates prove to be optimistic. While it seems plausible to believe that New York Health will prove to be cost-effective, it is uncertain whether the $45 billion in cost reduction Friedman estimates will be realized. To riff on a key provision of Murphy’s Law — anything that can go wrong most often will.
[Links to copies of Friedman’s full and summary financial analyses; of the New York Health Act; of the Senate/Assembly bill; and the county-by-county tabulation of estimated property tax savings can be found in Section VI at the conclusion of this article.]
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III – Political Context: No one reading this should anticipate that the final bill, arrived at after months of political wrangling and stakeholder lobbying, will resemble the straightforward bills still lodged in the Senate and Assembly Health Committees. There are two principal and conflicting perspectives on the nature of health care in the U.S., i.e., whether it’s a commodity to be bought and sold in the free or unregulated marketplace, or whether it’s a human and social necessity or right, not to be marketed but to be universally available. Given the predominance of the former view, there are many fingers in the health care pie, and their owners will be vying to be winners rather than losers in the political struggle that will ensue when New York Health is brought to open debate.
The insurance companies will be first in line, contending that New York Health threatens their very existence and will cost 25,000 employees their jobs. Big Pharma will be right behind, arguing that the loss in profits New York Health will cost them will interfere with their capacity to research new medications. A slew of other entities will follow, including many non-profits, arguing that New York Health will interfere with their missions as well as much needed revenue. As they see it, a free market economy such as ours requires freedom from government regulation and competition between providers to determine the cost and availability of a given product.
The Republican legislators they lobby and even some Democrats will agree with and support their contentions – belief and reliance on the free market as self-regulating is unquestioned. When those of us advocating for Single Payer put forward such quaint notions as “people over profits” and “health care as a right,” we’ll be talking right past them, promoting concepts they regard as discredited. The late Justice Scalia once compared health care to broccoli – one commodity to another; and Tom Price, Trump’s ethically challenged Secretary of Health and Human Services, has termed Medicare a governmental intrusion into the marketplace that disrupts health insurance competition and the market’s self-regulating capacity. If any one entity is responsible for the high cost of heath care, Price would argue, it’s the Federal government.
Which beliefs allow “capitalism forever” proponents to demean Medicare – and Social Security for that matter – as an “entitlement” and to ignore the fact that Medicare is an insurance program paid for in the same manner that New York Health will largely be, through payroll deductions. Ultimately, the presumed health care free market is actually monopolistic and will charge whatever the market and health care consumers will bear. Interestingly, the NY Times Book Review of April 9 featured on its first page a review of Elizabeth Rosenthal’s recently published An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (2017). Jacob Hacker, the Times reviewer, tells us that Rosenthal challenges Scalia’s “broccoli” analogy by reminding her readers that “… The health care market doesn’t work like other markets because – [and here Hacker quotes Rosenthal] – ‘what the market will bear’ is vastly greater than what a well-functioning market should bear… As per Hacker, Rosenthal describes American Health Care as not really a market; it’s more like a protection racket – tolerated only because so many different institutions are chipping in to cover the extortionary bill and because it’s our lives that are on the line” (Italics mine).
Rosenthal concludes by reminding our elected legislators that it’s their job to do what the presumed health care free market won’t do – to push back against the greed of its money-making stakeholders and provide the regulation and controls that the market can’t.
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IV – Single Payer Lobbying ,Talking & Listening Points: When Campaign for New York Health brought together over 500 New Yorkers from across the State to Albany on April 4 for a Single Payer Lobby Day and sent us into the Legislative Office Building to meet with key legislators, the implicit message they sent us to deliver was that only government, with all its acknowledged bureaucratic deficiencies, could bring comprehensive, cost-effective health care coverage to New York’s residents. Now the Campaign didn’t spell that out for us. Rather, our ostensible purpose was to persuade the Assembly majority that had signed us as sponsors of Blumenthal’s bill to continue to hold fast, and to shake loose in the Senate two more sponsors that would give Rivera’s bill a similar majority.
Many if not most of us assumed that if that were accomplished, New York Health would be a sure thing.
Those of us from the North Country who visited the offices of our Republican State Senators, Jim Tedisco and Betty Little, were quickly disabused of that notion. Tedisco’s and Little’s legislative aides both told us that neither Senator had even heard of the bill – our interpretation was that neither was particularly interested in New York Health and would do their damndest to ignore it. Little’s very resolute and experienced aide gave us a lesson on the Legislature’s legislative protocol: once a bill is in Committee — and both bills are in the Assembly’s and Senate’s Health Committees — only the Committee chairperson – in the Senate, that would be Kemp Shannon, from Long Island’s 6th S.D. – can bring it to a vote in Committee and from there to the Senate floor, assuming a majority of Committee members vote to release it. My guess is that the Campaign’s push for two more Senate sponsors to give the Senate bill a majority of Senate members was to provide it with momentum and prevent it from dying stillborn in the Health Committee.
When we return to see Tedisco and Little – and members of the Access to Health Committee which I coordinate are already working on that – we’ll make more explicit what we believe is their responsibility, viz., to join the effort to secure the best possible health coverage for their constituents. I have little confidence we’ll convince them to do so, not only because of what I assume will be their faith in the free market but also because they won’t be so eager to have a hand in what will be seen as a great Democratic victory. So then we’ll listen to their objections and try to determine whether there’s any room for discussion – whether their objections are ideologically bound or pragmatic, concerned with the cost and financing projected by the Democrats.
In short, we’ll take a pragmatic and evolving approach and avoid the liberal dogmatism that is just as off-putting as the Tea Party/Freedom Caucus variety. After all, we will be reaching across the great divide. That’s not to say we’ll surrender or conceal our core principle regarding the collective responsibility of all health care stakeholders, including our legislators, single payer advocates and all North Country residents, to establish an affordable and accessible health care system unburdened by the free market, competition and profit. So we’ll listen, learn and adapt our approach.
We’ll do the same when we reach out to the folks who should comprise our natural constituency – families and women with and without children. We’ll explain the potential benefits of single payer health and then we’ll listen, because most will have individual concerns that will have to be validated. I anticipate that those who have children or other family members who have long-term illnesses will be concerned about long-term coverage. I know of another advocate who’s very much opposed to a provision in NY Health bill that calls for care coordination for persons who’ve been labeled as mentally ill. She believes it’s discriminatory. So do I. We’ll listen and then invite them to join us and express those concerns directly to their legislators. The same approach will be used with small business people and with town and village supervisors and boards. Those who become interested in single payer insurance for their employees will be preoccupied with one issue – affordability. Can they contribute their 80% share to their workers’ health insurance or will it bankrupt them? Liberals characteristically give short shrift to the financial concerns of small businessmen and women – how many of them, particularly those whose businesses are seasonal, will be able to foot this bill?
Elected town and village officials will have had experience with this question, since they are obliged to provide health benefits to pubic employees. It will be important to hear what they have to say and enlist them in the single payer campaign wherever possible. I’ll be meeting with my town supervisor sometime within the next week or so and, if that goes well, with the town’s board sometime thereafter. I’ll let you know how I made out, what worked and what didn’t and what I learned from our give and take.
County officials and legislatures should be pleased with the bill, unless free market ideology trips them up. The large share of the property taxes each county collects that has been earmarked as payment to the State for their 15% Medicaid share will now remain with them. Politicians’ delight, they can cut taxes or improve services without raising taxes. Again, we’ll listen. One possible fly in the ointment here could be the bill that Stefanik has threatened to introduce that would provide upstate New York counties with the same financial windfall without being obliged to support singe payer. Remember, this was the clause that Ryan offered to insert in his American Health Care Act to cement upstate Republican support for the AHCA. This tactic didn’t work then, but Ryan seems to have a long memory where his humiliations are concerned.
In the long run, the biggest threat to the NY Health Act will be the lobbyists for Big Insurance, Big Pharma and the American Medical Association (AMA) and the substantial campaign contributions they represent. If you remember, private insurance, thanks to the Big Insurance lobby, occupied a central position In Bob Dole’s 1990’s health coverage plan, which eventually morphed into Romneycare in Massachusetts and then Obamacare. Big Pharma was conceded enormous profits by Bush II with Medicare Part D, when CMS, the Center for Medicare and Medicaid Services, was proscribed from negotiating with drug providers below-market prices for the medications purchased by Medicare subscribers.
The AMA opposed Medicare when it was proposed by Lyndon Johnson in 1965, fanning fears of socialized medicine, of long waits for treatment, of government interference with physician treatment prerogatives — yes, the same propaganda that was broadcast when the ACA was being debated in Congress and the same you can expect to hear whenever Single Payer insurance gets out of Committee and comes up for a vote. Primary care physicians are more likely to support single payer, as will rural health care providers because it will allow their patients ready access to the health care they provide. Mention single payer to medical specialists, however, and it’s as if they can visualize the millions of dollars they expected to earn forever beyond their grasp. They seem to forget that Medicare made them prosperous and that Single Payer won’t treat them shabbily. Nonetheless, most specialists will become employees under Single Payer insurance, obliged to forego their status as private providers and potentially wealthy entrepeneurs. They will accept Single Payer with great reluctance.
The most effective lobbyists, of course, will be us and those we attract to the single payer campaign, citizen lobbyists who can besiege their legislators with ‘phone calls, postcards and personal visits. More crucially, our citizen lobbyists will be able to testify at the hearings the Legislature is likely to hold once things heat up, and counter, with their stories, the self-aggrandizing arguments advanced by the BIG 3 lobbyists.
Another caveat: We are only at the beginning of what promises to be a long struggle. Ideas about how to conduct it will begin to flow once we fully engage in it. Of course, we don’t have to wait until then. Ideas and feedback re. the foregoing are welcome now. Better yet, join the still-developing North Country Access to Health Committee, which I like to think of as the action arm of the Health Task Force put together at this month’s first Grassroots Summit.
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V – Where to send your postcards, etc.: The Campaign for New York Health now has as its focus getting the New York Health Act out of committee, particularly the NY Senate’s Health Committee. Here is where your postcards, calls and visits need to be directed:
Senator Kemp Hammon (R.), 6th SD, Chairman, Senate Health Committee
The Capitol – Room 420
Albany , NY 12247
595 Stewart Ave., Suite, 540
Garden City , NY 11530
EMAIL ADDRESS: [email protected]
Senator Betty Little (R.), 45th S.D., Member, Senate Health Committee
(Clinton, Essex, Franklin, Warren and parts of St. Lawrence & Washington Counties115th AD, Clinton)
Legislative Office Building
Albany , NY 12247
Phone: (518) 455-2811
Fax: (518) 426-6873
5 Warren Street
Glens Falls , NY 12801
Phone: (518) 743-0968
Fax: (518) 743-0336
137 Margaret Street
Plattsburgh , NY 12901
Phone: (518) 561-2430
Fax: (518) 561-2444
EMAIL ADDRESS: [email protected]
James Tedisco (R.), 49th SD, member. Senate Health Committee
(Fulton, Hamilton, Herkimer, Saratoga, Schenectady)
(TEMPORARY) DISTRICT OFFICE
636 Plank Rd.
Clifton Park , NY 12065-2046
Legislative Office Building
Albany , NY 12247
FULTON COUNTY OFFICE BUILDING
223 W. Main Street
Johnstown , NY 12095
EMAIL ADDRESS: [email protected]
Billy Jones (D.), 115th AD (Clinton, Franklin, St. Lawrence)
202 U.S. Oval
Plattsburgh, NY 12903
Albany, NY 12248
Marc Butler (R.), 118th AD (Fulton, Hamilton, Herkimer, Oneida,
Albany, NY 12248
235 North Prospect St.
Herkimer, NY 13350
33-41 E. Main Street
Johnstown, NY 12095
(518) 762-6486 (?)
Dan Stec (R.), 114th AD (Essex, Warren and parts of Saratoga &
Albany, NY 12248
140 Glen Street
Glens Falls, NY 12801
7559 Court St. Rm. 203
PO Box 217
Elizabethtown, NY 12932
e-mail: [email protected]
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VI – Links to additional information:
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REMEMBER! Don’t mourn, organize. (Joe Hill)
Dr. Carney’s most recent posts are to be found here, along with a mostly complete archive of all articles he has written since his retirement from professional social work practice in 2010. All his blogs have as their focus issues pertaining to social justice; are generally placed in their historical context; and, ultimately, are subjected to in-depth analyses whose aim is to promote a full understanding of the issues being addressed.