(photo: Kevin P. Coughlin/Office of Governor Andrew M. Cuomo)
Lawmakers in Albany are again advancing the New York Health Act, which would abolish private health insurance and herd all New Yorkers into a state-run “single payer” plan financed with massive tax hikes.
Instead of building on recent progress—which has brought us closer than ever to universal health care coverage—this proposal would demolish the current system and put one-fifth of the economy under state control.
Here are 10 reasons why “Albanycare” is the wrong way to go.
It’s a Major Leap of Faith
Instead of modeling their plan on an existing system with a track record, the authors are attempting something radically different: a 100% tax-funded health plan, covering everyone and everything, with no limits on choice of provider, no premiums or copayments, and no private alternatives allowed. Nothing quite like it has ever been tried before—in the United States or anywhere else.
It’s Unnecessarily Disruptive
As of 2019, New York’s uninsured rate had dropped to a historic low of 5%, or about 1 million people, many of whom are eligible for existing programs. That puts universal coverage within reach through relatively modest investments and policy fixes. With a conversion to single-payer, the vast majority of the cost and effort would be focused on people who already have coverage—and who are by and large content with it. A single-payer system would also redistribute resources among providers, creating winners and losers with unpredictable effects on the stability of the system.
It Will Break the Bank
Even if you believe the new system can cover more people and more benefits at roughly the same cost (which is dubious in the extreme) this proposal would put the entire $300 billion health system on the state’s balance sheet—making the rest of government look small by comparison. At a minimum, the price tag could be expected to grow at roughly the rate of medical inflation year after year. Figuring out how to balance the budget of this one program—by cutting costs, raising revenue or both—would become Albany’s dominant obsession. Some level of rationing would be almost inevitable. Lawmakers would face choices between reducing payments to providers or limiting benefits.
It Requires Economy-Busting Tax Hikes
Financing single-payer—even at a cost-neutral level—would require state tax hikes on a scale never before seen in U.S. history. Some lower-income New Yorkers might save money compared to premiums, but only because their higher-income neighbors would pay drastically more. Those hardest hit by the taxes would be incentivized to move away, triggering a spiral of falling revenue and soaring tax rates. The state’s ability to raise money for other priorities—such as mass transit or renewable energy—would be diminished if not eliminated.
It Lacks Viable Cost Controls
The proposal would abolish existing restraints on spending (as flawed as they may be) without clearly identifying alternatives. For starters, most reimbursement would be on a “fee for service” basis, a model that encourages over-consumption—and rewards bungling providers by paying them twice, first to make the mistake, and then to fix it. The promise of “free” service without a consumer contribution, and without other constraints imposed by health plans, would encourage excessive use of certain tests and treatments, including many with limited or dubious value.
It’s Authoritarian
The bill mandates state-sponsored coverage for all New Yorkers, whether they want it or not, while effectively banning private insurance and private fees. Imagine imposing that level of government control over other necessities such as food, housing or education.
It Gives New Yorkers More Reasons to Leave
Wealthy individuals and businesses can easily avoid the new single-payer taxes by setting up residence in another state. People of even modest means who are happy with their current coverage might choose to live elsewhere. Medical providers who do well under the present system might decide they’re better off leaving. On the other hand, the offer of free long-term care would incentivize people to move here just before they enter a nursing home or seek other costly services.
It Leaves Too Many Questions Unanswered
The bill is long on promised benefits but short on details about the trade-offs. The most consequential decisions—starting with where to set tax rates and how to compensate providers—are left to be determined by future legislators, a future governor and a future panel of appointees. Nor has the proposal been subject to a full-fledged analysis or proper public hearings. Lawmakers should do their homework before passing what would be the most complicated and high-stakes program in state history.
It Depends on Trusting Albany
Running a health plan for 20 million people demands a level of competence and honesty that the state government has never demonstrated before. For a preview, look no further than New York’s Medicaid system, which is hugely ineffici >ent and riddled with waste and corruption. Time and again, Albany puts the interests of players in the system—especially those who can afford lobbyists and campaign contributions—over the needs of the vulnerable people Medicaid is supposed to serve.
It’s the Wrong Response to a Pandemic
The best way to fight a viral outbreak is to prevent it from spreading in the first place. That’s primarily the job of the public health system—which focuses on entire populations rather than individuals and does not depend on insurance companies for money. Doctors, hospitals, nurses, etc., play the essential role of treating those who do become sick, but they’re not the ones who order quarantines, limit crowd sizes, shut down non-essential businesses or mandate mask-wearing. Most hospitals and doctors became less busy during the height of the pandemic, to the point that many hospitals furloughed employees and needed financial bailouts. When hospitals did become overwhelmed with patients, it wasn’t because people lacked coverage, but because the public health system had broken down.
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Bill Hammond is senior fellow for health policy at the Empire Center. On Twitter @NYHammond.
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College graduation (photo: CUNY)
Abolitionist Henry Ward Beecher once said: “We should not judge people by their peak of excellence; but by the distance they traveled from the point where they started.” While my travels didn’t include the cobblestone streets and dirt roads of Beecher’s Gilded Age Brooklyn, his words certainly resonate. Although today I’m an incoming law student at Yale, I “started” in the redbrick labyrinths of Brooklyn’s multi-story housing projects. For me and many other Black youth of the 1990s, the calaboose-like atmosphere of New York City’s public schools sowed ignominy and self-doubt. “Zero tolerance” was more than just a catchphrase, it was as real as the metal detectors and uniformed police we encountered every day.
It should come as no surprise, then, that I was incarcerated before the age of 21.
Reportedly, Black high school dropouts face 7-in-10 odds of going to prison by their mid-thirties. I was no exception. When I entered prison in 2000, New York’s overall investment in rehabilitative programming had already waned. The declining emphasis on rehabilitation coincided with a national trend toward harsher punishments. Beginning in the 1990s, as incarceration rates grew, state and federal resources were being diverted from educational programming in prison. In 1974, there was one educator or vocational instructor for every 53 incarcerated people, and one for every 67 in 1990. By 2005, however, there was one educator for every 112 incarcerated people. In contrast, the number of security hires within that 30-year period remained largely proportionate to the growing prison population. Our national priorities around crime were quite obvious, and reform through education simply did not make the cut.
Perhaps the most salient disinvestment in prison education was the 1994 Crime Bill, which ended federal Pell grants for incarcerated students. In 1995, New York’s Republican Governor, George Pataki, followed suit and eliminated tuition assistance for incarcerated students. This decimated college programming throughout New York’s prisons, reducing the total number of incarcerated students to just under 2%. The programs that remained were privately funded and scarce.
The prison I spent 17 years in didn’t have a degree-conferring college program until 2016, the year before I was released. Once out, I continued with my classes through independent study and later matriculated at Cornell in 2018. I graduated in 2020 and will begin law school in the fall.
College transformed my life. Like nothing else, it let me know society was willing to give me a second chance—that my road to redemption was no fool’s errand. Honestly, I don’t know where I’d be without college. And yet, over 98% of folks inside New York’s prisons are without it. Fortunately, Congress recently reinstated Pell grants for incarcerated students, and that’s a big step in the right direction. New York, however, is lagging behind.
Despite the Democratic super-majorities in both houses of the state Legislature, New York’s ban on tuition assistance—known as TAP—for incarcerated students remains a relic of the failed policies of the 1990s. To date, college enrollment in New York’s prisons has remained dismal even with the increased aid offered by Second Chance Pell, which temporarily restored Pell grants for qualifying programs. As it stands, less than half of New York’s prisons offer college, and programs can enroll only a fraction of eligible students at the prisons that do. This is especially harsh given that New York law allows people to leave prison six-months earlier if they earn 24 college credits. But dangling a ‘carrot’ you’re unwilling to buy with your own buck isn’t sound policy, it’s irresponsible.
One of the most rewarding parts of my college journey was witnessing how it inspired my nephew, Darryl. He was just months away from graduating high school when I was released. As a child, he lived in Brooklyn’s Howard projects, in Brownsville—where the popular motto is “Never ran, Never will.” With his dad in prison, by most metrics he was likely to land there, too.
Darryl’s father, my older brother, happened to be my cell-mate for the better part of ten years. We shared a bunk, celebrated birthdays and holidays together, and even took many of the same college courses. With indeterminate life sentences, we didn’t know we’d ever get out. It wasn’t until I went before the parole board that I realized how inspired Darryl was by our educational journey. In a letter to the parole commissioners, Darryl described me as “the smartest person he’d ever known” and said that he was moved by us to graduate high school and enroll in college. Not only did we make it home to see Darryl graduate, but we were thrilled to help him organize his college dorm room.
College in prison does not simply benefit incarcerated individuals. It benefits families and communities that have been devastated by mass incarceration, and it benefits the entire state. New York needs to do more than simply encourage private donors to sponsor these programs. Tuition assistance should be resto >red for all eligible students, including incarcerated ones. There is a thirst for more educational programming inside prison, and it’s certainly time for New York lawmakers to turn on the TAP.
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Darnell Epps is an advocate, writer and alumni of the Cornell Prison Education Program. Darnell currently works as an analyst for Ithaka S+R and will matriculate at Yale Law School in the Fall of 2021. On Twitter @DarnellEpps7.
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Scenes across America (photo: Edwin J. Torres)
At first glance, Bronx County in New York and Cowlitz County in Washington State appear to be worlds apart. Cowlitz County is rural and has a mostly white population that once enjoyed a thriving resource-based economy that has all but disappeared. Bronx County, part of New York City, is urban density magnified and has a diverse population spanning ethnicity, income, and certainly race. Despite these seeming differences, a recent study published by Federal Emergency Management Agency (FEMA) provides empirical evidence that Cowlitz County and the Bronx are two counties most at-risk in the nation for specific natural threats due to community disaster vulnerability.
The COVID-19 pandemic has laid bare the fragility of our communities. Examining the causes can provide a much-needed bridge of understanding between urban and rural communities to help bring our country together. The Biden-Harris American Rescue Plan is a good start to building back better and recognizing that urban and rural communities have more in common than divide us.
FEMA’s National County-by-County Index ranks the risk to each of the nation’s 3,100 counties and 73,000 census tracts from 18 separate natural threats -- including sea level rise, tornadoes, avalanches, wildfire, heat waves, floods, and storms. The index also assesses 78 socioeconomic factors such as a community’s poverty rate, racial composition, percentage of people with high-speed internet, housing quality, homeownership rates, education levels, and affiliation with religious and civic groups. These factors add an important component to the assessment as they reveal how a community will suffer from a disaster overall and how quickly it might recover.
Using the FEMA index, Scientific American recently published an article that named Cowlitz County as most at-risk for sea level rise and named Bronx County as most at-risk for tornados. This conclusion may appear nonsensical when you consider that Cowlitz County is 50 miles inland of the Pacific Ocean and tornados in Bronx County are extraordinarily rare. However, this vulnerability is more understandable when you factor in accelerating climate change with existing challenges: decades of bipartisan neglect from policy-makers, job loss, lack of investment in basic infrastructure like high-speed internet and water systems, lack of high-quality education, decreased affordability and access to health care and healthy and safe housing, lack of public housing, the existence of food deserts, and rapid gentrification. Like so many very urban and ver >y rural counties, these communities have experienced the immeasurable hardship of generational poverty, the loss of family, friends, and neighbors to diseases of despair, and have watched generations of children struggle from want of opportunity and hope.
Right now, America must find a way to address three grave threats – the COVID-19 health crisis and equitable economic recovery, racism and violence, and climate change. Real progress can be achieved when people in urban, suburban, and rural communities understand that we all have shared values, common challenges and, to a certain degree, the same sense of rage (although it has manifested differently). Change and progress requires a willingness to rebuild the broken structures that have caused communities like the Bronx and Cowlitz counties to be left behind. It is essential we proactively address the core inequalities and foster a new economy that prioritizes shared prosperity and climate action.
In the 21st Century in the United States geography should not be destiny. Living in the most urban or rural areas of our nation should not limit opportunity. Our diversity is our nation’s greatest strength and foundation of our democracy. For generations, we have been divided and over the past few years partisan rhetoric and cultural division have thwarted progress toward the common good.
Our nation needs healing. The American Rescue plan is a good first step. We must work together to build the bridges necessary to address the issues of our time – equity, racial justice, defense of democracy, and climate change.
We must “Build Back Better.” Let’s get started.
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Michael Blake is born, raised, and lives in The Bronx. He is a former three-term New York Assembly Member representing the 79th Assembly District in The Bronx, former Vice Chair at large of the Democratic National Committee, former Obama-Biden White House appointee and current CEO of Atlas Strategy Group, Inc. Teresa Purcell was born, raised, and currently lives in Cowlitz County after being gone for 26 years. A national political, communications, and organizing consultant, she has worked in 36 states and specializes in work in rural America and with BIPOC communities. She is a former candidate, leadership coach and trainer, and hosts a weekly radio show called Building Bridges in rural Washington. On Twitter @MrMikeBlake & @Teresa_Purcell9.
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