Universal healthcare has suddenly become a political possibility in New York State, and its implementation would be transformative. The New York Health Act (NYHA) is a bill that will create a universal healthcare system for all New York residents and workers with coverage beyond any private insurance plan and zero premiums, deductibles, or copays. The NYHA will cover mental healthcare, dental, vision, reproductive healthcare, gender-affirming surgery, and long-term care, far more than what even expensive private insurance plans currently cover. Our current healthcare system is both inefficient and inequitable—this is a state of affairs we have become inured to. But alternatives do exist, and the NYHA is a concrete opportunity to make things a bit fairer.
Since it was first introduced nearly 20 years ago by Assemblyman Richard N. Gottfried, and later brought to the senate by Senator Gustavo Rivera, a great deal of energy has been spent refining and assessing the law. The nonpartisan RAND Corporation analyzed it on behalf of an organization created by for-profit insurance companies and, to their chagrin, concluded that it would save New York State billions every year, save at least 90 percent of New Yorkers thousands of dollars, and, most importantly, save lives. The bill is self-funding, as it includes the new income taxes needed to fund it. Only the top five percent of New Yorkers are expected to pay more for healthcare than they do now, with most of those costs being shouldered by the top one percent, the top 0.5 percent, and the top 0.01 percent.
The establishment of a single pool of insured people is one of the key ways the NYHA saves so much money. The state will be bargaining with healthcare providers over prices from a negotiating position never before seen in American healthcare, and it will be doing so knowing it is beholden to the public interest rather than the need to generate profits. The other main reason the NYHA saves so much is because American healthcare is so uniquely inefficient. If we remake this system into something simplified and streamlined, we won’t need to choose between costs and services. Administrative costs, including executive salaries, account for around 12 percent of the operating revenue for private insurance companies. Medicaid and Medicare operate at around four percent, a little higher than most foreign single-payer systems. Under the NYHA, no opaque bureaucracy designed to deny coverage and maximize extracted profits will leech money out of the system. Nothing will stand in the way of the people who should be making medical decisions: patients and healthcare providers.
Whims of historical circumstance and relentless lobbying from the insurance industry have shaped our current system to be regressive: to afford coverage, households in the lowest wealth quartile pay a far larger percentage of their income (an average of 34 percent) than households in the highest quartile do (an average of 24 percent). The New York Health Act reverses this massive transfer of wealth up the socioeconomic ladder, and it only asks the richest of the rich to pay a percentage or two more than the poorest of the poor pay right now. Governor Cuomo opposes the law, but he has been weakened by scandal after scandal and currently lacks the political capital to veto it. The budget for New York that just passed included a new tax on the ultra-wealthy that Cuomo had previously vowed never to sign—proof of his present vulnerability. The institutional failure of the American healthcare system has been laid bare by the challenges posed by the COVID-19 pandemic, and healthcare reform has rarely felt more urgent to so many. Most importantly as a matter of pragmatism, for the first time ever the NYHA is supported by a majority of lawmakers in both chambers of the state legislature. If it’s brought to the floor it will pass.
Passing the NYHA will dramatically improve the lives of New Yorkers. Artists, in particular, will benefit immensely from the security that a robust safety net brings. Healthcare’s legal ties to formal employment represent a unique burden for self-employed and creative workers. The federal government underwrites employer-sponsored insurance by making those payments tax deductible for individuals and corporations. This policy leaves hundreds of billions of dollars on the table and much of the federal tax that self-employed people pay goes to cover the gap in revenue. In order to have health coverage, then, many artists pay into a system that actively hurts them. Speaking more generally, the thousands of dollars saved by New Yorkers will open up new demand for creative goods. Unemployment is projected to drop by at least two percent. With more and more New Yorkers able to imagine options beyond a life of brute subsistence, many will be able to pursue their passions, driving engagement and investment in the arts. The choice between a necessary medical procedure and attending a concert, or between prescription drugs and buying a painting, will be eliminated. With more income and a stronger safety net, New Yorkers who otherwise might not have been able to will be free to open galleries, publish journals, and put on shows.
The 2021 New York State legislative session ends tomorrow, on June 10, and the NYHA has not yet been brought to the floor for a vote. Even as the session closes, the bill’s supporters have not given up. During a legislative session on June 8th, Senator Jabari Brisport commented on various bills, even linking laws on turtle crossings and kelp farming to the urgent need to pass the NYHA. He found novel ways to communicate to the Senate the harm that’s being done to New Yorkers every day the NYHA fails to come to a vote. If necessary, our efforts will continue into next year’s session. Passing the NYHA will catch us up to every other developed country, save lives, save money, and give New Yorkers better access to art. It will make a life spent pursuing one’s passion a little less tenuous.