Two posters hang on the door of New York State Assembly member Richard Gottfried’s Albany office. One has a picture of Dr. Martin Luther King Jr., underneath a quote: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” The other says “Healthcare is a Human Right!” and urges the reader to “Pass the New York Health Act.”
First elected at age 23, Gottfried is now 71 and one of the longest-serving legislators in New York history. He has sponsored the New York Health Act in the Assembly since 1992. The Assembly has passed the bill, which would establish single-payer health care in New York, in the last four legislative sessions; now that the State Senate is also under Democratic control, it has a real opportunity to become law.
Gottfried is optimistic. After all, his Senate colleagues not only support the bill; many of them actively campaigned on it. While granting that there would be “nervousness” to move forward on the part of Senate leadership, he believes that, given the level and consistency of support for single-payer health care “not only among self-identified Democrats, but particularly among independents” and the number of senators who cosponsored the Senate version of the bill, “there will be vocal and negative voter reaction” if the Senate fails to “fulfill its promises.”
Still, even for those who say they support it, the bill isn’t as easy to sell constituents on as you’d think. In a recent interview, Assembly member Catalina Cruz told me she is for the bill, but shares concerns raised by “union colleagues,” like whether it would negatively affect certain contracts and whether retirees who have paid into the system will continue to benefit if they move out of state.
“First of all, a large part of labor in New York very strongly and actively supports the bill and has for some time,” Gottfried said when presented with these concerns. “The New York State Nurses Association was part of a group that, 28 years ago, persuaded me that I should be for single payer.”
Major unions that support the bill, he said, include 1199, the health-care workers; 32BJ, the building service employees; and RWDSU, the retail workers, as well as “a large part of” the CWA and the UAW. Some union leaders, however, argue that they’ve ceded wages and benefits in exchange for union health plans and the New York Health Act would take away a key bargaining chip.
To Gottfried, that “misses the point.” Nearly all health-care plans now, union or otherwise, have deductibles, co-pays, restricted networks, and out-of-network charges, he pointed out. In fact, he said, “I’ve never heard of any union health plan that is as good as the New York Health package.”
In New York City, Gottfried added, municipal employees have had a deal for more than 30 years under which the city pays 100 percent of the premium. Under the New York Health Act, the employer has to pay at least 80 percent of the payroll tax that will fund the plan. Gottfried tells public-sector union members in New York that if they can get their employer to pay 100 percent of about $20,000 in premiums, they should be able to get the city to pay 100 percent of $6,000 to $8,000, and push for the savings to be used to increase wages and non–health care benefits.
“Their answer…is often something like, ‘We’ve already negotiated for 100 percent of the premium; why should we have to bargain again?’” In a tone of mild frustration, Gottfried answered the hypothetical question: “Because it would put more money in your members’ pockets…and get them better health coverage.” Furthermore, he said, “Public employees who retire and move out of state still get their retirement benefits, including retiree health coverage…. we put that explicitly in the bill.”
Gottfried has spent nearly 30 years making the case for the New York Health Act; he can recite the pros and counter the cons in his sleep. The insurance industry’s claim that only 5 percent of New Yorkers lack coverage, and the problem can be solved simply by getting those people on Medicaid “completely ignores the reality that 95 percent of New Yorkers who have health coverage are constantly being knocked around and shortchanged and abused by that coverage,” Gottfried said. There is no way to fix the current system without eliminating insurance companies, because the money New York would save by doing so is “absolutely essential to delivering the full benefits” of single payer, such as expanding coverage, including long-term care coverage, and protecting patients from deductibles and out-of-network charges.
“Anybody who tries to sell the snake oil that getting the last million New Yorkers into health insurance is all we need to do,” he said, “is deliberately or negligently missing the point.”
The point, to Gottfried, is that single payer is a moral imperative, which is why he sees many of the questions skeptics raise as nitpicky or irrelevant. But he doesn’t dodge one of the biggest: Can the New York Health Act be funded without raising taxes? “To do it, you need to convert premiums and other out-of-pocket spending into a smaller number that is paid through taxes,” he acknowledged. “If you focus on whether we’re spending more money on taxes, then you’ll say we’re spending more money on taxes. If you focus on how much New Yorkers spend, and how much of what they spend actually goes for health care, and how much they get to keep in their pockets, then [you’ll see that] we’re saving New Yorkers money, and getting them better health care.”
As for the fears of Democratic leaders like Governor Andrew Cuomo and Senate majority leader Andrea Stewart-Cousins, both of whom have publicly signaled that they won’t raise taxes, Gottfried said, “A pledge not to raise taxes should not prevent you from lowering the cost burden on New Yorkers…. If you can save New Yorkers billions of dollars by converting spending to the public sector, that shouldn’t violate anybody’s pledge.”
Asked how serious Cuomo is about supporting single payer—the governor says he likes the idea, but has hardly been a full-throated proponent—Gottfried remains optimistic. “Unlike about 48 other governors. Governor Cuomo says single payer is the right thing to do,” he says. But what about the difficult, practical work of making it happen? “I’d be surprised if the governor’s thinking evolves in the next couple of months,” Gottfried allowed, “but if and when the bill is on the floor of the State Senate, ready to be passed, I think we will start having serious conversations with the governor.”
For the bill’s critics, another sticking point is the Trump administration’s likely refusal to approve state waivers for single-payer health care. But, although it would “certainly be simpler to run the New York Health plan with federal cooperation, and it would even save the federal government money,” Gottfried said, “we can still run the New York Health Act by various mechanisms around or through Medicaid and Medicare and the Affordable Care Act.” The bottom line: “We can do it legally without federal waivers.”
What can be done to help get the bill to a vote? Gottfried said that he and Senator Gustavo Rivera, the bill’s Senate sponsor, need to continue answering questions and “explaining the merits of the bill,” as well as aggressively reaching out to groups that have questions about it and encouraging them to “come tell us” if there’s anything they think needs to be nailed down or changed. Gottfried cited productive discussions with labor unions, physicians, and the hospital community. Community organizations and grassroots activists also need to “keep up their advocacy,” he said, and “keep the fires lit under legislators.”
Given the national political climate, Gottfried believes it’s especially critical for states that can “move aggressively forward with a progressive agenda” to do so, in part because of the difference it can make nationally. The Children’s Health Insurance Program began in Minnesota; several years later, it was adopted by New York. “And in almost no time,” he said, “every state in the union had a children’s health-insurance plan.” New York can now do the same for single payer. If a couple of states enact single-payer legislation, “I think it’s only a matter of time before it becomes nationwide.”