Christopher Carroll

For decades, universal healthcare in this country has seemed a pipedream, an idea that was legislatively and politically impossible to achieve and one that was reserved for the furthest extremes of the political left. Though politically that remains the case today (see “repeal and replace”), universal healthcare isn’t an issue owned only by unrealistic hippies or hyper-progressive politicians. It is an issue that has moved further to the mainstream.

In Washington, D.C., legislation has been introduced in Congress by Senator Bernie Sanders (“Medicare for All”) and Representative John Conyers (H.R. 676) that would create healthcare for all Americans. Representative Conyers’ bill has been co-signed by 117 Democrats in the House, and though there is absolutely no chance these bills will pass in 2018, there is no doubt that universal single-payer healthcare is now an important goal of a substantial faction of the Democratic caucus. Individual states have attempted to pass legislation as well, most notably – and unsuccessfully – in Vermont and California. While efforts on both coasts have failed, momentum towards a single-payer system has been building in New York for years, and New York is now looking to provide an example for the nation to follow.

Assemblymember Richard Gottfried (D – Chelsea, Hell’s Kitchen, Midtown), the chair of the Health Committee and the longest tenured member of the Assembly, is the lead sponsor of the New York Health Act, which would establish a universal healthcare system funded through a progressive payroll tax, making healthcare available for all, regardless of age, sex, income, or condition. Studies estimate that this visionary legislation would lower healthcare costs for 98 percent of New Yorkers, something that all can agree is a good thing, regardless of political leaning or ideology. However, though this bill has passed the Assembly three times, it has failed to achieve the support necessary in an IDC-supported Republican-controlled Senate to achieve passage and make its way to the governor.

Even if they gain control of both the Assembly and Senate, Democrats will find that the details of legislation become more exposed as the political realities of passage become less challenging. Similarly to the GOP’s failure to repeal the A.C.A. in 2017 after passing a repeal bill seven times, passing a single-payer healthcare bill will be extremely difficult unless serious policy issues are addressed in the legislation.

LABOR IS MOBILE

Any state solution that uses state residency as the determining factor for who qualifies for healthcare must account for one simple but fundamental truth: labor is mobile. It is extremely common for people to work in states in which they do not live, which has important implications for a payroll tax-funded, residency-based healthcare system.

Musicians are a prime example. Many musicians live out of state but work in New York City, or live in New York City and work out of state. Musicians also tour for months on end and work for out-of-state employers. Legislation must accommodate both those who work in New York but live elsewhere and those who live in New York but work elsewhere without putting an unfair burden upon them, while also ensuring that employers are not incentivized to hire out-of-state employees so as to avoid the payroll tax that funds the New York system.

Legislators must also ensure that a state-based solution does not compromise healthcare for retirees who live out of state, and also preserves union-provided healthcare systems that rely on economies of scale to negotiate lower rates for their participants.

These are some of the challenges that have prevented our elected leaders from finding state-based solutions to universal healthcare and why many believe that universal healthcare must be implemented at a national level if it’s to be financially viable.

However, it cannot be denied that the cost of healthcare in this country is crippling (pun intended) and that, together with the cost of housing, families are struggling to get by. The fact that we are home to the most advanced healthcare facilities and physicians in the world matters little when the care cannot be accessed or afforded. A solution, either state or national, must be found. Leaving Americans to fend for themselves against pharmaceutical companies and insurance corporations isn’t good enough.

Ultimately, finding the right solution at the state level may not be possible legislatively and finding the right solution nationally is not yet possible politically. Progress is being made, but one thing is clear: healthcare isn’t easy. Who knew?