Frequently Asked Questions

Single Payer means a government-run health plan that is responsible for payment of claims for health services.

“Universal coverage” refers to a health care system where every individual has health coverage. On the other hand, a “Single Payer system” is one in which there is one entity—usually the government— responsible for paying health care claims. Single Payer is one form of universal coverage.

Single Payer is where government runs the health plan. Medicare for All includes a combination of public, government run health coverage and private health coverage, but it is managed by the federal government.

Very few countries have a true Single Payer system where the government pays all claims. Only Canada, Taiwan and South Korea have true Single Payer systems, whereas other countries such as Spain, Germany, Netherlands, and other European countries have a mixed system of public and private financing. The U.K. and Scandinavian countries employ what is called the “Beveridge Model” which means the government is both the payer and provider of health care.

Most Single Payer systems offer complete catastrophic and preventative care coverage, but may not include other benefits such as long term care, prescription drug coverage or home care services. In Canada the government does not cover prescription drugs, home care or long-term care, prescription glasses or dental care, and limited coverage is provided for mental health care.[1] In other systems, such as South Korea, long term is not covered and copayments cover roughly 30% of costs.[2]

[1] https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act-frequently-asked-questions.html#a3

[2] https://www.med.or.jp/english/journal/pdf/2009_03/206_209.pdf

All Single Payer programs are financed through taxes.

The RAND Corporation recently conducted an independent analysis, which found that a Single Payer system will initially require an additional $139 billion in new taxes, quickly rising to $210 billion. Including long-term care benefits increased the required new taxes to $182 billion initially, rising to $253 billion.

Access to health care services, such as specialty hospitals, will likely be limited under Single Payer. In their independent analysis, the RAND Corporation indicated “there would still be unmet patient demand” that can result in “long wait times for appointments or providers not accepting new patients.” They also noted that Single Payer is likely to result in “changes to providers’ recommendations regarding courses of treatment or through constraints on technology and equipment.” The “wait line” for health services has been experienced in those countries that have Single Payer.

NYHA is legislation that would impose a Single Payer health care system in New York State.

NYHA would provide comprehensive inpatient, outpatient, drug, dental, vision insurance and long term care.

Any person “residing in New York” is eligible for coverage under NYHA. NYHA is blind to tax filing and immigration status, meaning that a person simply has to declare an intention to stay in New York to be eligible.

Currently 95% of New Yorkers have health insurance. NYHA would result in approximately 800,000 newly insured individuals.

NYHA prohibits premiums, deductibles, copays, or coinsurance to any beneficiary; you pay for it through a mandatory payroll tax instead.

NYHA prohibits network restrictions meaning you can utilize any approved health care provider who agrees to accept the rate NYHA pays. It is important to note that the RAND Corporation estimates significant spending reductions in provider payments in order to control the cost of the NYHA.

Under NYHA, the State of New York would be the only payer of health care services, meaning approval for health care services would lie with the government.

The RAND Corporation found that the NYHA will initially cost $309 billion, quickly rising to $461 billion. Long term care benefits increase the cost to $369.1 initially billion, rising to $538.2 billion.

New York’s 2018-2019 entire budget for all services (health, education, transportation, etc.) was $168 billion in total spending. According to the RAND Corporation, Single Payer would require an additional $210 billion in new taxes ($253 billion with long term care) when fully implemented — more than doubling the entire State Budget for one program.

In general, Single Payer would at least triple New York State taxes. The specific answer is difficult to determine since the current proposal doesn’t provide details. It requires the Governor to develop a plan that would be based on financing Single Payer through two new taxes: 1) a payroll tax with an 80% employer contribution and 20% employee contribution, and 2) a tax on other taxable income (e.g., interest, dividend, etc.).

NYHA calls for implementation within two years. No other country has implemented a Single Payer system in less than a decade; Canada and the U.K. did so in approximately two decades.

There are a number of legal impediments that could delay implementation. New York would have to apply for Medicaid waivers on an unprecedented scale. Federal law (the Employee Retirement Income Security Act of 1974 “ERISA”) also presents substantial obstacles that could prevent or delay implementation of NYHA. The bottom line is that New York would require federal action, likely by both the Executive and Legislative branches.

Although this is a complex question, there are several outcomes that are known. Recent analysis estimates that New York will lose 160,000 jobs if NYHA is implemented, equivalent to job losses experienced in the Great Recession. NYHA’s economist believes that New York will regain those jobs within two years, which has never occurred in the New York labor market. Lost jobs represent approximately $9 billion in wages lost to the implementation of Single Payer. The NYHA would require $250 billion in new taxes that will be paid by individuals and businesses. We don’t know the impact of an increase this size because it has never been attempted in New York.

Much like other Single Payer systems, a single entity (New York State) would pay the claims and universal coverage would be extended to all persons residing in New York. Coverage would be publicly financed through dedicated taxes.

NYHA differs from Single Payer in other countries in significant ways. First, in benefits: NYHA covers benefits such as prescription drugs, home care, behavioral health and long term care that aren’t covered by any other country. Second, NYHA prohibits copayments and coinsurance, which is a typical financing mechanism in Single Payer countries. NYHA also differ significantly in reimbursement. Countries that have enacted Single Payer institute price controls that mandate payments at a specific level, which is achieved through the monopsony power of the government. NYHA requires reimbursement to be negotiated with providers, while also allowing providers to collectively bargain. Lastly, the NYHA relies heavily on federal funding to continue at the current levels.

No states have adopted a Single Payer system. Vermont passed legislation to enact Single Payer but was forced to abandon it due to costs. Colorado placed Single Payer on a ballot initiative, where it was defeated 70-30. California also attempted to pass Single Payer legislation, but failed to do so when a legislative analysis suggested its cost could be $400 billion a year.