A New York Legislator Makes A Case For Universal Health Care
Colorado’s pending vote on universal health care this year has renewed discussion of the topic among health care reform advocates around the country. There are a handful of other states that have active movements promoting universal health care, or single-payer systems, including New York.
Manhattan assemblyman Richard Gottfried is campaigning for a bill, the New York Health Act, that passed the Assembly last May and is up for a vote again this year. It’s part of a more than two-decade crusade by the legislator to create a single-payer plan in the state. Gottfried believes he’s closer than ever.
He spoke with Side Effects Reporter Michelle Faust about why he thinks his plan is a better option for his state.
Michelle Faust: More people than ever before are insured under the Affordable Care Act. Is universal health care still viable in this era?
Richard Gottfried: The Affordable Care Act has made a lot of important improvements in our health coverage system. Its basic flaw is that it leaves us in the hands of insurance companies. And with an insurance company based system, people face rising premiums, even worse than that, rising deductibles and copays and restricted provider networks where you pay enormous out-of-network charges if you go to a doctor other than the one the insurance company picked for you. All of this is a major obstacle to getting health care for a lot of families and a major obstacle to family financial stability.
The New York Health Act would create a universal, publicly funded, totally comprehensive health plan for every New Yorker that would be funded not through regressive premiums and copays, et cetera, but through broad-based assessments on taxable income based on ability to pay. So, the average (in fact 98 percent of New Yorkers) would be spending a lot less for health coverage and health care under the New York Health Act than they’re spending today.
MF: Do you mean they would be spending less in taxes than they are paying in their copays and deductibles and premiums?
RG: Right. The progressively graduated assessments, unless you’re really in the top one or two percent, would be less than what 98 percent of us spend on health coverage, premiums, and health care out-of-pocket costs.
MF: What is your reaction to the demise of Health Republic (one of the dozen health insurance co-ops across the nation to recently fail)?
RG: Well, I think we’re still learning what went wrong with Health Republic. Part of it may be that they had a more attractive provider network and so therefore more than the average number of patients who needed health care were signing up. And if you’re an insurance company, you make money by avoiding having people who need health care sign up.
I think the key lesson from the Health Republic collapse [is that] when they collapsed all of a sudden people were unable to go to their regular health care provider, in many cases. Health care providers are worrying whether they’re going to be paid for the care [they] delivered last month. That would never happen again with a universal, publicly funded health plan like the New York Health Act.
MF: I’d guess that’s some of the concern that some people have. For example, when doctors say that if we move from the plans that we have now to something universal they would be paid less or they wouldn’t get paid at all.
RG: The New York Health Act would actually raise reimbursement rates in many cases. The Medicaid program would no longer be underpaying practitioners. A lot of the Medicare reimbursement rates would be leveled up to current commercial rates.
The guarantee that health care providers will be well taken care of is that when we’re all in the same boat, rich and poor alike, New Yorkers with wealth and power are going to make sure that their doctors are paid well. And if their doctors get paid well, my doctor and your doctor will get paid well, because it will all be the same health plan.
People when they hear this say, “This has got to be magic. How do the numbers work?”
The numbers work because we save tens of billions of dollars that we now waste on insurance company administration and profit, and the administrative costs that health care providers have to fight with insurance companies.
Also, a single unified health plan would have real bargaining clout with drug companies. So the outrageous prices we’re seeing today for a lot of drugs, New York would have the power to bargain those prices down.
MF: In the state of New York, as one of the solutions or attempted solutions to help people who fall in a weird gap where they don’t qualify for Medicaid, but can’t afford their premiums, the state now has a basic plan (The New York Essential Plan). I would assume that you don’t think that goes far enough.
RG: The new Essential Health Plan that will start being available in January is really good, and it’s going to help a lot of people. But it’s going to be more expensive for the state to help pay for because it’s run through health companies. It will still have restricted provider networks. If one of the people that are on this plan wants to go to a doctor that isn’t in the network, they’re out of luck.
Months ago, I had a wisdom tooth pulled and I’ve got terrific health coverage. I’m a state employee. The oral surgeon that I went to cost $1,200. In Manhattan, that’s not a big surprise. My high-quality, state employee health coverage paid $56. Now, somewhere in New York there’s a dentist who pull your tooth for $56. I don’t think I want to go to that dentist. And I don’t think you would either.
MF: When the Affordable Care Act had its last challenge in the Supreme Court, a lot of people were saying that the most conservative justices support it is because it’s a business issue. There are a lot of businesses that are making more money and have more customers because of the ACA and the individual mandate.
RG: The Affordable Care Act has certainly been a big benefit to the insurance industry. It has also helped a lot of consumers, because things like pre-existing conditions, limits, and the like have gone away. People tend to forget, though, that in New York we outlawed all those things over 20 years ago.
It has still made insurance available to a lot of people. But what people want is not insurance. They want health care. And having insurance from insurance companies and other health plans doesn’t always get you health care. And the New York Health Act will provide coverage that guarantees health care.
MF: You’ve been working on this for quite some time. Do you think that you’re gaining ground?
RG: I’ve been at this for a long time on this bill. A lot of things that are worth doing take a long of time. We got the bill passed in the state assembly in May  by the vote of 92-52, which has been a big step forward. I think that we’re helping convince people that this is not a terrific idea that could never happen. It’s a terrific idea, but it’s really achievable. And as we get that word out, I think that we’re creating a tide that will is ultimately going to be inevitable and unstoppable.
MF: In Vermont, this didn’t necessarily work. They decided that it was going to be too expensive. Why is New York different?
RG: New York is different, partly because we have a much stronger economy statewide than Vermont does. A lot of that is based in Manhattan, where I’m from, maybe not as much in Rochester. But the enormous economic engine in Manhattan, in lower Manhattan, will make this plan viable and affordable statewide.
Vermont wasn’t quite a single payer system, and so they lost a lot of the potential savings and they lost a lot of the potential income. So, whatever went wrong in Vermont, here in New York we know it can work.
We had an economic analysis done by the head of the economics department at the University of Massachusetts in Amherst, which demonstrated that with reasonable assessments on taxable income (reasonable meaning almost everyone would be spending less than they are now) we could have net savings in New York of $45 billion a year, which is over $2,000 on average for every New Yorker. We could do a lot to energize our economy by freeing up 45 billion dollars a year.