Surveying the crowd of more than 100 gathered in Cortlandt Oct. 10 for a panel on single-payer health care, Assemblyman Richard Gottfried said the courthouse was “about the most packed room I’ve been at for this kind of event.”
That’s with more than two decades, the Manhattan Democrat added, of attending community discussions on single-payer care since he first sponsored a bill for state-funded health care coverage in 1992.
The panel, organized by Ossining Assemblywoman Sandy Galef, filled the seats at the Cortlandt Town Hall to capacity, leaving some attendees to crowd into the back and even sit on the floor.
The crowd size could be read as a sign of increasing interest, or at least awareness, in the merits for a government — funded single-payer health care system. Long a goal of progressive Democrats, single-payer health care has pushed its way into the national health care debate even as a Republican-controlled Congress in Washington, D.C. continues a push to replace the Affordable Care Act.
Independent U.S. Sen. Bernie Sanders of Vermont made single-payer health care central to his platform for the Democratic presidential nomination in 2016. This year, his single-payer bill in the Senate has 10 Democratic sponsors, including U.S. Sen. Kirsten Gillibrand of New York.
Meanwhile, Gottfried’s New York Health Act single-payer bill has passed in the Assembly three years in a row. The bill’s counterpart in the state Senate, however, has yet to pick up the needed votes.
Galef said she organized the discussion because single-payer, and health care policy in general, is the subject her constituents email her about most frequently.
“I think we can all agree that health care is a fundamental right,” Galef said in opening remarks for the panel. “How we go about making it affordable is what is at stake.”
Galef said her goal was a “balanced, pro and con” discussion on single-payer health care from state experts. She stayed mostly neutral through the debate, though she did vote last year in favor of Gottfried’s single-payer bill.
Gottfried opened the discussion with a pitch for his “Medicare-for-all” style bill, which would replace the state’s system of private insurance, Medicare and Medicaid with a single government payer covering all of the state’s close to 20 million residents. The coverage would have no out-of-pocket costs or network restrictions.
The assemblyman said the bill starts with the “basic principle that every American should have access to health care.”
“The one way to provide all of us with health care and financial security and to do it in the most practical and most affordable way, I believe, is to take insurance companies out of the picture and to create an improved Medicare-for-all system,” Gottfried said.
Gottfried cited an analysis of the bill that said it would provide net savings to New Yorkers of $45 billion per year. He said the program would be funded through a progressive increase in state payroll taxes and on taxable nonpayroll income, such as capital gains and dividends.
Bill Hammond, director of health care policy at the Empire Center for Public Policy, a fiscally conservative think tank, countered that while working toward universal coverage is the right goal, “this bill, in this state, at this time, is a mistake.”
Hammond questioned whether the bill was affordable for the state and if it was the best use of its funds, citing one analysis that the single-payer bill would require the state raise $92 billion in additional revenue. That’s more than double the total the state currently raises in taxes.
A lot of that money would go toward providing insurance for people who already have it, he said. A better policy, Hammond argued, would directly target the 5 percent of people in the state who are currently uninsured.
“It would not cost anywhere near $90 billion to insure those people,” Hammond said, “and it seems to me more logical to attack that genuine problem rather than trying to replace the health care of every single person in the state.”
Thomas Lee, chief of neurosurgery at St. John’s Riverside Hospital in Yonkers, also argued against single-payer health care at the panel. Along with concerns about cost and the likelihood of longer wait times for patients seeking care, he said a single-payer system could foster anti-competitive behavior among health care providers.
“The Affordable Care Act itself has already consolidated the health care marketplace in New York,” Lee said. “Larger and larger hospital systems have become even larger. They have become way too big to fail.”
He said the “regulation of a single-payer system will kill any small physician practice and the physician-patient relationship,” by increasing the amount of compliance work that require the time and resources of physicians and their staff.
Elizabeth Rosenthal argued as a physician in favor of a single-payer system. The retired dermatologist is a faculty member at Albert Einstein College of Medicine in the Bronx and a board member of the New York Metro chapter of Physicians for a National Health Program.
Rosenthal described how frustrations working with insurers through her own practice led her to use her retirement to advocate for a single-payer system.
“It’s a moral issue,” Rosenthal said. “It’s a crime and disgrace and immoral that our rich, rich country cannot provide medical care for all its people.”
An important step for single-payer, Rosenthal said, is to push back against the idea that the government can’t do anything right.
“We have a single-payer system that has worked in this country for over 50 years, it’s called Medicare. It works great,” Rosenthal said. “Expand it, improve it and give it to everybody. It’s not a big experimental thing. We don’t have to reinvent the wheel.”
The conversation stretched on for nearly two hours, including a series of submitted questions from the crowd on how the bill would work and on possible alternatives.