Of course Mayor de Blasio, card-carrying progressive that he is, supports setting up a government-funded single-payer health plan in New York, and declared as much in his State of the City speech on Thursday.

Just 48 hours earlier, though — and perhaps unwittingly — de Blasio made the best case yet that single-payer would be a colossal waste of time and money.

On Tuesday, the mayor went on national TV to announce that his administration will soon “guarantee health care for every New Yorker.”

Calling it the “most comprehensive plan in the nation,” de Blasio promised full medical care for 600,000 uninsured city residents — including undocumented immigrants — without need of state or federal legislation.

What’s more, he said he could do it for the low, low price of $100 million, mere rounding error in the context of an $89 billion city budget.

It turns out — surprise! — Hizzoner was engaging in a bit of hype. His plan is actually a relatively modest expansion of existing city services.

But he illuminated a timely truth: New York is closer to achieving universal access to decent health-care than is commonly understood. And the state, like the city, could close the remaining gaps without anything close to the massive expense and disruption that a Medicare for All-style single-payer system would entail.

After five years of Obamacare, the state’s uninsured rate has dropped to a historic low of 5% or so. Many of those who still lack coverage are poor enough to qualify for government-funded insurance through Medicaid or the Essential Plan, and could sign up tomorrow.

Everyone else — at least within the five boroughs — has the fallback option of using New York City Health + Hospitals, a city-owned network of hospitals and clinics that has a long-standing policy of charging only what people can afford.

De Blasio’s new proposal would steer some of the uninsured into MetroPlus, a city-run health plan. For those who can’t afford the premiums, he wants to do a better job of delivering free or reduced-price services through Health + Hospitals.

So his “guarantee” largely boils down to repackaging the safety net that the city has been providing all along.

But de Blasio plan also has the virtues of being doable, affordable and targeted to the people who most need help. Contrast that with the single-payer legislation being debated in Albany, known as the New York Health Act.

Rather than focusing on the roughly 1 million uninsured, it would force all 20 million New Yorkers to change to a new plan, operated and paid for by Albany. It would jack up taxes by an estimated $139 billion — much more than doubling the state’s already heavy tax burden. Plus, it would rejigger the revenue streams for every health-care provider in the state, with a destabilizing effect on access and quality.

By the way, only a small part of the massive price tag would go toward improving things for the poor and uninsured. Most of the $139 billion would be spent on reinventing the wheel for people who already have insurance, and who don’t necessarily want to change it.

The New York Health Act is the equivalent of a multi-organ transplant for a patient who would be better off with a course of antibiotics.

This is not to say that de Blasio’s plan is a sure-fire success. Health + Hospitals has been struggling with deficits for years, despite heavy taxpayer subsidies, and it’s unclear how it would afford an influx of even more patients who can’t pay their full bills.

Nor would this approach work the same way in other parts of the state that have no equivalent of the city’s government-owned health system. Upstate and on Long Island, any comparable guarantee would have to be delivered through private, not-for-profit health-care providers — which, after all, are supposed to provide charitable benefits in return for their tax-exempt status.

That would undoubtedly require more money and effort than de Blasio’s plan — but the challenges would be trivial next to the almost certain morass of single-payer.

Whether he intended to or not, the mayor has illuminated a saner path to universal coverage in New York State. Gov. Cuomo and the rest of Albany would do well to follow it.

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

You may also like

How a Blast From the Past Could Save NYC Again

Forty-five years ago this month, then-Gov. Hugh L. Carey and the state Legislature passed a landmark law, the Financial Emergency Act, designed to rescue Gotham from imminent bankruptcy. Read More

The Numbers Debunk Cuomo’s SALT Gripes

For the better part of three years now, Gov. Cuomo has been pounding SALT — the federal income-tax deduction for state and local taxes. Read More

Experts Weigh in on How to Save New York City Post-Coronavirus

"With massive budget deficits looming, Mayor de Blasio’s post-pandemic plan boils down to hoping for a stopgap federal bailout and asking Albany for permission to issue billions in deficit bonds. This won’t solve the problem. New York needed a much leaner, more efficient public sector even before the novel coronavirus blew a hole in its tax base." Read More

The Fear Behind City Union’s Strike Threat

Polling this month showed that two-thirds of the nation’s teachers would prefer to stay out of the classroom this fall, and teachers unions across America are poised to keep schools from reopening. The unions say the safety of their members is their top concern, yet, truth is, their bottom lines are just as critical. That’s because the pandemic represents their biggest financial threat since teachers won the right to stop paying them. Read More

Tax Day 2.0 Marks the End of NY’s Economic Expansion

New York’s slow reopening has begun just in time for a virtual April 15 — Tax Day 2.0, pushed back three months by the novel-coronavirus pandemic. In a way, it’s the end of an era: The tax returns due to be filed on Wednesday will report incomes earned in 2019, the close of a decade-long economic expansion. Read More

Say Yes to Long Island City Development: NYC Must Salvage the Plots Intended for Amazon’s Second HQ

Predicting doom and gloom for New York is all the rage. While we do face difficult fiscal choices for the next several years, those with skin in the game are contradicting this “death of New York” narrative — and offering a way out. Developers across the city are asking communities for nothing more than regulatory permission to add jobs, mixed-income housing and new high-quality public spaces. Yet just this week, Councilmember Jimmy Van Bramer denounced a multi-billion dollar investment in offices and homes in Long Island City — shortly after denouncing 2,700 new mixed-income homes in Astoria. Read More

Instead of Facing Fiscal Crises, NYC, State are Burying Their Heads in the Sand

The headlines surrounding this week’s New York City budget naturally focused on #DefundthePolice demands. But for all its larger potential implications for New Yorkers’ security and quality of life, the partially illusory $1 billion “cut” in the New York Police Department budget was a sideshow in fiscal terms. Read More

A Corona Commission for New York

New York is finally ahead of the coronavirus, but its outbreak stands as a world-wide horror story. A sophisticated city was caught unprepared and suffered some of the worst levels of infection and death. The need for an investigation is clear. The harder question is who can credibly take the lead. Read More

Subscribe

Sign up to receive updates about Empire Center research, news and events in your email.

CONTACT INFORMATION

Empire Center for Public Policy
30 South Pearl St.
Suite 1210
Albany, NY 12207

Phone: 518-434-3100
Fax: 518-434-3130
E-Mail: info@empirecenter.org

About

The Empire Center is an independent, non-partisan, non-profit think tank located in Albany, New York. Our mission is to make New York a better place to live and work by promoting public policy reforms grounded in free-market principles, personal responsibility, and the ideals of effective and accountable government.