Richard Gottfried is a former Assembly Member and sponsor of the New York Health Act
A recent post on Educators of NYC by Peter Goodman opposes the New York Health Act, the bill to create universal, publicly-funded, publicly-accountable comprehensive health coverage (“single-payer”) for every New Yorker.
This focuses a lot on the point that many details of the system are not spelled out in the bill. Of course not. Does a union contract name all the thousands of medical procedures and drugs the health benefit might cover and the price for each? But the bill spells out – in law – the key fundamentals that make clear that New York Health is the right choice for all of us, and far better than any other health plan, union or otherwise.
The NYHA specifies that anything covered by Medicare, Medicaid, state insurance law mandates, and any state or local public employee health plan will be covered for every New Yorker. This includes long-term care (home care and nursing home care). It’s dramatically broader coverage than any union health plan.
It guarantees no premium, deductible, co-pays, restricted provider network or out-of-pocket charges. The bill has strong enforceable language guaranteeing fair and adequate payment methodologies and rates.
All guaranteed by law, not at risk every time a union contract is re-negotiated.
The plan will be publicly-accountable, not run by an insurance corporation accountable to stockholders. The governor and legislators, and their families and friends, will all be covered by the plan, so they’ll have a keen interest in making sure it treats patients and providers as well as can be. And 20 million New Yorkers will benefit by being in the same plan.
The bill spells out that it will be funded by a progressively-graduated tax, based on ability to pay. For payroll income (anything subject to the federal FICA tax), the employer must pay at least 80% of the tax; the employer share could be more, especially through collective bargaining. (For state and local public employees, whatever percentage of the health benefit premium the employer currently pays, the bill requires the employer to pay at least that percentage of the NYHA tax for the employee, going forward.) The first $25,000 of a person’s income will be exempt from the tax; for Medicare enrollees, the first $50,000 of income will be exempt (acknowledging the federal money they draw into the system).
The tax will also apply to non-payroll income – e.g., dividends and capital gains – that is subject to the state income tax. That’s where really serious income is earned in our economy.
The exact brackets and rates will be set by the governor and legislature when the plan is ready to be implemented. That makes sense: today we don’t know what income levels and distribution, and health care prices, will be at that point.
Today, no one can tell any union member what their health plan will cost them or what the details will be in the next contract. Union leaders constantly say that every time they’re at the bargaining table, they have to choose between protecting the health plan or other wages and benefits.
Many studies by major consulting firms (e.g., RAND) and academics have analyzed state and federal single payer plans, including the NYHA. Almost all agree: the plan will produce billions in net savings over the current system. By eliminating insurance corporation bureaucracy, marketing and profit, cutting what health care providers spend fighting with insurance corporations, and slashing drug prices using the bargaining power of 20 million “covered lives,” NY Health will save almost $60 billion a year. After paying for long-term care and picking up out-of-pocket costs, the net savings will still be almost $20 billion a year.
Those savings, and the funding mechanism based on ability to pay, means almost every New Yorker will spend less than they now do for health care and coverage.
The article cites a report by a Canadian think tank called the Fraser Institute attacking the Canadian single-payer system. Fraser is a Canadian equivalent of the extreme right-wing Heritage Foundation (the people now hosting Project 2025).
The article expresses concern about the growing power of for-profit equity taking over health plans and health care providers. That’s a very important concern. It is made possible by the concentration of economic power exerted by a handful of huge health plans and pharmacy chains. We need a countervailing power serving the public interest. The answer is a universal publicly-run and publicly-accountable single-payer health plan – the NYHA.
Some unions say they support a universal health plan but say it should be done nationally. With the current climate in Washington, a national plan is not likely any time soon. And a plan enacted in New York will be more favorable to employees and patients than one enacted in Washington.
