Single-Payer Mayor
Mayor Bill de Blasio’s announcement yesterday that New York City would begin guaranteeing health care for all New Yorkers, through a new program, NYC Care, made for a busy morning. The mayor unveiled the plan on MSNBC’s Morning Joe, and then at a press conference at Lincoln Hospital in the Bronx. De Blasio did much talking—declaring that universal health care was a moral imperative, and that New York City would not wait for Washington to recognize that “health care is a human right”—but he wound up saying very little, because he didn’t discuss the plan’s cost, propose a budget, or explain why the city needs such a program. And he drew attention away from the paradoxical fact that NYC Care promises to pay for every medical service that one can imagine—at apparently little to no cost for taxpayers.
Let’s start with what we know. New York City’s uninsured population numbers about 600,000 and consists of three main groups: young people who choose to go without insurance, illegal immigrants, and those who cannot afford an Obamacare plan and are ineligible for Medicare or Medicaid. NYC Care would provide these individuals with primary and specialty care, hospital services, and prescription-drug coverage. These services will be free to those who can’t pay anything; others will pay what they can afford, on a sliding scale.
This is where the plan gets tricky. According to de Blasio, NYC Care will cost $100 million a year—amounting to $167 for each of the 600,000 beneficiaries. You don’t have to be a health-care actuary to guess that $167 won’t go very far toward covering even a healthy person’s insurance costs. One estimate pegs the cost of health insurance in New York City at just under $5,000 per person. In 2015, per-capita health spending in the city totaled $6,056.
But it’s no use getting bogged down in that $100 million figure, an estimate tied to the mayor’s vague assertion that NYC Care will save money by reducing ER visits—a highly unlikely but typical suggestion of single-payer advocates, who like to claim that their plans will “pay for themselves.” Single-payer plans never pay for themselves, and they almost always cost more than their initial estimates. As if to confront this economic reality, de Blasio pledged to “put the money in to make it work.” But that only arouses more concerns, especially considering that, as the mayor himself pointed out, “when you know something is guaranteed, you act differently.” Exactly. And when that “something” is “free health care,” you tend to use more of it—lots more.
That brings us to another peculiar feature of NYC Care: it’s not health insurance, but rather, the promise of free health care. While one of the mayor’s goals is to “boost enrollment in MetroPlus,” the city’s affordable public option, the main objective is to “connect hundreds of thousands of New Yorkers who are ineligible for health insurance . . . to reliable care.” It’s important to take de Blasio at face value on this one: he’s going way beyond the city’s preexisting safety net and guaranteeing free health services to the city’s uninsured. It’s socialism without budgets, quite possibly unsustainable—and it will surely cost more than $100 million a year.
As with most single-payer plans, NYC Care is about politics as much as it is about health care. There’s a reason that Mayor de Blasio announced the initiative first on a national television program—the same reason that he took a jab at Albany, and Governor Andrew Cuomo, for dragging their feet on state-wide single-payer, and attacked congressional Republicans for “trying to reduce the amount of healthcare people get.” Any Democrat who has the slightest hope of running for national office needs to prove his single-payer bona fides. De Blasio has now checked that box.
Announcing NYC Care may help de Blasio score some political points, but the odds of it succeeding are low. When reality sets in, and the political benefits have been tabulated, perhaps the mayor will set aside the moral crusades and opt for sensible reforms instead.
