This is a follow-up to my piece in the April issue of Allegro and John O’Connor’s response in the May issue.

I would like to respond to John O’Connor’s article in last month’s Allegro by stating I believe John and I agree on some key points. I would like to see everyone in the U.S. have health coverage that is comprehensive and not so costly that it breaks family budgets. I would also like to see health coverage decoupled from employment.

John writes about the resolution passed at the AFM Convention last summer: “In spite of an attempt to substitute another resolution unsupportive of single payer by the convention committee assigned to vet the resolution, the delegates overwhelmingly voted for the original resolution (it is rare for delegates to vote against a committee recommendation), underlining how deeply musicians feel about the issue.”

This is a matter of opinion and a reading of the room. The substitute amendment from our committee was not “unsupportive” of single payer; it was more inclusive and open to any method leading to universal coverage. I chose not to continue the argument on the convention floor because my reading of the room was that delegates wanted to move on to more immediate matters. The vote was not unanimous and the passage of the resolution has changed nothing at the AFM or anywhere else.

I’d also like to weigh in on the “watered down” characterization of the committee’s recommendation that John wrote in the International Musician.. Our committee spent quite a bit of time on this proposal. When John presented his resolution to the committee, he came with no research or data or even Congressional bills to back it up. We asked for the text of the legislation he referred to and he instead gave us talking points from Bernie Sanders’ website. I brought the text of the two bills to the committee myself.

John quotes some exit polls from the 2020 election as showing the majority of the public favoring a government run plan. I already addressed this by reporting more recent Gallup polling data from 2023.

John writes “Local 802 Executive Board member Martha Hyde in her article in the April Allegro makes a case against single payer and suggests that a better plan would be a program in Maryland known as All Payer.” This misrepresents what I wrote. I was not making a case “against” single payer. Rather, I was pointing out that there are other ways to cover everyone and control costs besides “single payer,” and that Maryland’s model is used by a number of other countries.

John doesn’t provide any sources for his assertion that Maryland’s “insurance costs outpace normal inflation.” However, data reported in Health Affairs on Maryland’s system show “standardized per-capita Medicare spend declined from 1 percent above the national average to 1 percent below” from 2015 to 2019, and that measurable quality had improved. Of all 50 states, Maryland had under half the national average cost for complex Covid hospitalizations. 

According to a 2024 survey, the shared cost of premiums for Maryland employees with single, employer-provided health insurance was ranked 36 out of 50 states. (In this survey, a ranking of number one signified the most expensive down to number 50 as the least expensive.) The difference between Marland (ranked 36) and Michigan (ranked 50, the least expensive out of all states) is $8 per month. (An interesting tidbit: New York was ranked 41 in this survey, which is still better than Maryland.).

While insurance premiums “outpace inflation” as John says, the overall average Maryland premium increase for 2024 is 4.7 percent compared to the U.S. annual inflation of 3.4 percent (as of April 2024). But Maryland benchmark plan premiums have actually decreased by an average of 8 percent annually from 2019 to 2022.

There is also no guarantee that healthcare costs won’t continue to rise faster than inflation under Medicare For All. The cost savings outlined in the current House and Senate proposals are already being used in many places — and costs are still outpacing inflation.

John also does not provide any source for the claim that 300,000 Marylanders remain uninsured, so I did the leg work. First, I did find data from a few years ago that backed up John’s assertion. These 300,000 uninsured people represent about 6.1 percent of the Maryland population — a small but unacceptable percentage. According to these data, Maryland ranks along with Washington as the 18th best out of 50 for covering its population.

However, these numbers may be out of date. This more recent study shows that Maryland cut its uninsured rate by over 53 percent from 2022 to 2023 — 5.8 percent down to 2.7 percent — and now leads all other states by this measure. While Maryland leads, New York is not far behind — ranked 8th lowest. (Perhaps New York should develop an all-payer model as Vermont did after it failed to implement single payer because of the steep tax increase it would have required.) 

The Maryland legislature is attempting to pass the Access to Care Act, which would allow undocumented folks (about one third of the uninsured) to obtain insurance from the state marketplace (the federal ACA still excludes undocumented immigrants). 

The remaining uninsured two thirds are not covered for a variety of reasons: some think they don’t need it, others think it’s too expensive, others think avoiding insurance will save them money. 

All of this can be addressed with education, more robust subsidies for premiums and more. Cost is the major stumbling block and cost is driven by increasingly advanced and expensive medical technology, and by overuse of interventions. All have to be addressed and can be, hopefully without making the coverage worse. Whether the government (us taxpayers) or private insurance companies pay, someone will pay and that will always be passed down to us, the patients.

John writes: “Sister Hyde states that one of her main reasons for opposition to Medicare for All is, according to AFM convention delegates from red states it ‘would not fly’ in their states.”

Once again, John misrepresents and oversimplifies what I wrote. I have never opposed single payer or Medicare-for-all on a policy basis. I oppose the dogma that there is only one way to approach this problem. I’m pointing out that there are other ways to achieve universal coverage as evidenced by a variety of systems in other countries that I outlined here and that an honest, problem-solving approach would be to study all available models.

I also raised some concerns at the convention which I continue to have with the latest House and Senate Medicare-for-all bills.

The House bill attempts to cover reproductive services by classifying pregnant people (a legally protected category) and “including termination of pregnancy” (not a legally protected category) in its non-discrimination clause. Ditto for gender identity. It does explicitly state that abortion and gender-affirming care (both currently illegal in some states) are covered. This could mean a fight on the federal level over protected categories with a possible outcome of excluding those services in all states under Medicare For All.

The language on enrolling undocumented immigrants is vague. All “residents” are covered and “residents” are enrolled at birth “or upon establishment of residency in the United States.” It is not at all clear how that will work and I can only conclude that even under Medicare-for-all there will be a percentage of folks still without coverage.

As I said before, even if this proposal passed Congress and was signed into law (unlikely), the Supreme Court would almost certainly strike it down. Instead of doing this the hard way by trying to impose a centric structure on 50 sovereign states and comparing that, as John suggests, to the Civil Rights Movement, a better strategy might be finding a model more likely to succeed in attaining the goal of universal coverage, given our governance structure.

John goes on to advocate for the New York Health Act (NYHA), a 30-year-old proposal for a single-payer system in New York. The NYHA has improved since Local 802 considered and declined to endorse it some years ago but the  current version still raises some possible concerns for 802 members.

The payroll tax plan for out-of-state workers which in previous proposals had taxed New Jersey and other out-of-state residents who work in New York for a benefit they could not access has evidently improved a bit. Employers and workers “shall be able to take a credit against the payroll taxes each would otherwise pay as to that individual for amounts they spend respectively on health benefits (A) for the individual, if the individual is not eligible to be a member of the program, and (B) for any member of the individual’s immediate family.” The best I can make of that language is that the payroll tax to finance this program can be credited back to a worker from New Jersey who has to obtain coverage elsewhere.

Additionally, the act stipulates that in order for a New Jersey or other out-of-state worker to be eligible, “Every New York resident and individuals employed full time (emphasis added) but living out of state will be eligible to enroll.” It is hard to imagine many out-of-state musicians would qualify under that “full time” rule and if they did, they would have to choose New York based healthcare providers rather than choosing providers in their own towns. 

There are also concerns for 802 members who are either wholly or partially self-employed.

Section 4 iii 2 (b) Payroll tax. (i) of the act says, “The income to be subject to the payroll tax shall be all income subject to the Medicare Part A tax. The payroll tax shall be set at a percentage of that income, which shall be progressively graduated, so the percentage is higher on higher brackets of income. For employed individuals, the employer shall pay eighty percent of the payroll tax and the employee shall pay twenty percent of the tax, except that an employer may agree to pay all or part of the employee’s share. A self-employed individual shall pay the full tax.” (Emphasis added). Note: 1099 income is considered self-employed income.

I have lived without health coverage (or with fractured coverage) and have dealt with medical debt during some periods of my life. That is one reason I began researching causes and possible solutions to our problem. I am delighted to work with anyone who is serious about finding and getting behind a viable and sustainable way to detach health coverage from employment and cover everyone. I will work with anyone who is open minded about researching the multiple pathways to that goal. When people insist there is only one way to solve the problem I cannot help but wonder if they have other political goals besides universal coverage. To use the Cornell Institute of Labor Relations phrase: universal health coverage is my “North Star.”

Local 802 Executive Board member Martha Hyde was a delegate to the 2023 AFM Convention. Among other duties, she serves as a trustee on the Local 802 Musicians Health Fund.

Opinion pieces in Allegro do not necessarily reflect the views of other board members, officers, members or staff of Local 802. To inquire about submitting a piece to Allegro, send an e-mail to Allegro@Local802afm.org.