Medicare For All – The Visible Challenge

Languishing in the New York State Legislature (since 1992) is a bill – The New York Health Act  (Medicare for All in New York State) – which has the potential to transform the lives of all NY State residents as well as serve as a model for the nation as a whole.

The (Richard) Gottfried/(Gustavo) Rivera bill – A5248/S3577 – would create a universal, comprehensive system of access to free, quality health care for all.  However, its chance of passage is almost non-existent.  Powerful forces including doctors, hospitals, pharmaceutical and insurance companies as well as some NYS legislators themselves are allied against it. Equally important is the absence of political will to execute meaningful change. Most of all we have a public (citizenry) that is poorly served and largely  unaware and disinterested in holding legislators accountable  for the quality, affordable health care that is central to a good life.

We, in NYCADA, have always believed that quality health care is a right – not a privilege. Yet, the US is the only industrialized nation which does not offer free, universal, quality health care to all.

Progress toward that goal has been slow and painful.  Medicare (for the elderly) and Medicaid (for the poor) – results of 1960’s Great Society legislation – represent a giant step forward.  Passage and implementation of the Children’s  Health Insurance Plan (CHIP) represented another, much smaller but no less important, step.  The 2010 Affordable Care Act (Obamacare) which brought expanded health care to millions of uninsured American citizens changed the landscape and continues to do so despite being under siege by the Republican Party.

Still, fifty-five (55) years after Medicare/Medicaid our system of health care for profit remains a blot on our society.

The major players – doctors, hospitals, insurance companies, pharmaceutical and medical device enterprises – are formidable obstacles to achieving a system which guarantees free, universal access to all. It is they and the lobbyists they fund – six for every legislator – which have stopped health care reform dead in its tracks.

Health care as an industry has grown dramatically over past decades. It represents eighteen percent of GDP, funded by the federal government (50%), individuals (25%) and employers (25%). Our trillion dollar deficit is largely due to rising Medicare/Medicaid costs and we spend about that much annually on payments to doctors, hospital executives, medical device makers and pharmaceutical companies. All this with poor outcomes and enormous costs as life expectancy here is less than in comparable industrialized nations. In the midst of all this is the rise of a reimbursement system which emphasizes elective and specialty care while, simultaneously, discouraging hospitals from meeting basic health needs.

One major result of the novel coronavirus pandemic is that it highlights the inequities and inequalities in our capitalist system, a system which values producing products over providing services. US health care is, indeed, the engine of inequality. If there is one action which we, as a nation, could take to improve access to free, universal, quality health care, it is to eliminate the role of the employer. Yet, the idea of employer-based health care coupled with the outsized role of the private insurance company is sacrosanct in our society. The terms “single payer” and Medicare for All are anathema to large numbers of Americans.

Because employer-based insurance plans cost an average of $21,000 per family or $7,200 a single person, companies calculate whether a prospective employee’s value to the company can cover both salary and benefits.  Too often the result is that the company outsources the job elsewhere to a company with fewer benefits and career advancement prospects.  And, more often than not, that prospective employee is unskilled or less-skilled.  The end result is a decline in the labor market for less-educated, unskilled workers.

Today, there are nineteen (19) million Americans without health care and 74 million without dental coverage. Those without health insurance are largely minorities and low-income whites. There is evidence that some low-income whites without health insurance would rather die than share access to Medicaid with black and brown people.  Prices in the US for almost any health care product or service tend to be twice as much as in a comparable industrial society.   Yet efforts to educate Americans to the advantages of a comprehensive, universal health care system continue to fail as citizens cling to the employer they often hate and the private insurance company they have learned to love.  Co-insurance, co-pays and deductibles are meaningless in this equation.

Nowhere is this more true than the labor movement.  Over the past years membership in  the labor movement has declined.  In 2019 union membership among wage and salary workers was 10.3 percent (14.6 million).  In 1983 union membership was 20.1% (17.7 million). Of that number (14.6 million)  Public Sector union membership (33.6%) was more than five times higher than Private Sector union membership (6.2%).  Half of union membership lives in five states – NY, NJ, PA, CA and IL.

There are many reasons for the decline of the labor movement. They include a Congressional failure to enact legislation favorable to workers and unions (minimum wage increases), the concomitant passage of legislation hostile to unions (Janus), a federal executive hostility to unions (Reagan), and, indeed, actions within the labor movement itself which discourage membership growth (hostility to immigrants).

Studies suggest that union membership strongly supports the New York Health  Act.  Benefits under the Act include comprehensive coverage, -primary, dental, inpatient, long term care with no deductibles, copays, limited provider networks or out-of-network charges as well of out-of-pocket expenses or “surprise” charges.

However, there is intense opposition to its passage – primarily by union leaders. Opposition includes a basic fear by union leaders that providing health care is the major attraction to union membership. Given the antipathy toward unions generally, this is a powerful deterrent.  Leaders also feel that over the years they have given up potential benefits to secure and retain health care for their members. Support for the New York State Health Act may deny them benefits for which they have made past sacrifices and there is no assurance that the benefits they currently enjoy would be sustained, much less expanded.  Further, unions are inextricably bound to the private insurance companies which subsidize members’ health care benefits.  In the process, the union employs a sizeable staff to administer the health care program, all of whom would lose their jobs with universal, government-operated health care.

Efforts to address these fears through the concept of a “just transition” have little credibility as leaders require assurances that every member who loses his administrative job will have a comparable one with equal compensation.  Implementation costs are projected to require $139 billion in new tax revenue. Union leaders have little faith that these funds would be forthcoming.  Peripheral arguments include concerns for current members who live outside New York State as well as those retired and living elsewhere. In short, leaders lead the resistance to change.  Finally, union leaders feel allegiances with their counterparts who provide moral support when bargaining with their own employers. Attempts to address their concerns are on-going but deep down there is the view among the bill’s advocates that no compromise is possible in the face of union leader resistance.  

Meanwhile union leaders need to recognize that unions are increasingly bit players in larger dramas. Membership is at its lowest point since the New Deal with entire segments of the economy unorganized including some essential workers. These unorganized front line workers – all with inadequate and some with no health care – are not going to wait for current labor leaders to accept and lead them.

The New York Health Act sits on the desks of Albany legislators. Assembly Speaker Carl Heastie has shepherded it through his House several times.  Senate Leader  Andrea Stewart Cousins continues to sit on it, fearful – it is said – that the Democrats newly elected from Long Island who gave the Party control of the Senate will be unseated, if the bill is passed.   Governor Cuomo has made no moves to support it.

Meanwhile, millions of New York State residents go with inadequate or no health care.