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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. Well, it's budget season in Albany, and if that makes you yawn, don't allow it to because between now and April 1, they're going to be deciding on so many consequential things. This looks like a particularly consequential budget year in Albany on housing, on crime and criminal justice, on climate, and there is new talk of an amended single-payer healthcare bill at the New York State level as these talks are entering the home stretch. More than a million residents don't have health insurance statewide, according to New York City data.

Joining us now to discuss a bill that he's introducing to create a single-payer New York State healthcare system, as well as other priorities in the budget, is New York State Senator and Chair of the State Senate's Health Committee Gustavo Rivera. He represents District 33 in the Bronx, which includes Kingsbridge Heights, Fordham, Belmont, Riverdale, Norwood, Bedford, Pelham Parkway, Van Nest, and Morris Park. I think I got them all. Senator Rivera, good to have you. Welcome back to WNYC.

Senator Gustavo Rivera: It's a pleasure to be back, and yes, I will not be doing a lot of what, as you put it, yawning. Not a lot of yawning in the next couple of weeks. Not at all.

Brian Lehrer: Yes. We had the, I guess, now retired assembly member Richard Gottfried on the show, he used to be chair of the Health Committee and has long proposed, I think his first version of it was in 1992, New York State single-payer. Now you've picked up the mantle, can this happen this year?

Senator Gustavo Rivera: Well, first of all, yes, the original version was introduced in 1992. I've been in the Senate for 13 years myself, obviously, nothing compared to the 52 years that Assembly Member Gottfried served. I've been in the chair of the Health Committee for the last four years, this is my fifth year as a chair, and I've had the bill for that entire time. As far as it happening this year, it has not been reintroduced yet because there's, as you mentioned, some amendments that we're making to make it a little bit stronger, particularly as it relates to protections for our brothers and sisters in labor. I've always believed that it is an essential thing to do. It is an incredibly difficult thing to do both politically and technically, but it is an essential thing to do because if we believe that health care is a human right, then we have to move towards a system where that happens.

I will be reintroducing the bill shortly. I mean, obviously, we're in the middle of the budget season, so I'm focused on that mostly, but it will be reintroduced, and hopefully, we'll get some movement this year.

Brian Lehrer: Why is organized labor skeptical?

Senator Gustavo Rivera: Well, I should mention first that there are many folks who are not skeptical in organized labor, whether it's the nurses or 1199, or CWA, or RWDSU, CIR, SEIU, which represents the Committee of Interns and Residents, et cetera. These are all folks who are supportive of the bill, but it is indeed something that some folks in public sector unions are skeptical. I call it the burden-to-hand problem. It is a fact that these folks have over the years negotiated for benefits that they have in their hand. What we're arguing, those of us who support the system, is that we're going to give not only their members but every single New Yorker a better floor, a higher floor, than what they have right now. That is a difficult thing to be able to convince people, particularly when the last couple of decades, we have been that this notion, [clears throat] excuse me, in our head that the way to get good health care is to get a good insurance product.

That has been baked into our head. I always remain convinced that in good faith, we can find solutions. Certainly, as it relates to public sector unions, I remain open to their concerns, and we're going to be making some changes that I think will address some of their concerns. Hopefully, we can get them on board.

Brian Lehrer: Would your version at the New York State level cut out all private insurance companies from the business like Bernie Sanders would have at the national level?

Senator Gustavo Rivera: That is precisely the case. What we want to do is we want to provide a system in which there are no networks, no premiums, no copays, no deductibles. When people hear that, they think, "Is this possible?" I would say to them, absolutely. Not only is it possible, there's a version of this system that is working in every single modern democracy in the world. In the case of New York State, I believe that not only do we have an opportunity to do it but an obligation, and I believe that we can actually be a model for the rest of the country. I certainly believe that that is the case, and we need to take insurance companies who are in the business, not of providing care, but of limiting care so that they can keep more of our money, we need to move away from that. We need to move away from a system in which health care is a commodity.

Brian Lehrer: Even if there is a government single-payer plan, money is not unlimited, right? President Biden just proposed a tax increase on people making more than $400,000 a year, or I should say, and I was trying to make this distinction actually, listeners, I'm going off on a tangent here, and Senator, but it's not on people making more than $400,000 a year, it's on income of more than $400,000 a year. The Medicare tax hike that President Biden proposed is only on that share of income that exceeds $400,000 a year, the rest of your income, if you make anything up to that, would be taxed at the existing rates. Senator, it's an example, nonetheless, of the fact that Medicare is running out of money unless something is done.

I'll tell you, my parents are on Medicare, which is supposed to be the gold standard, and they're always saying to me, "Medicare will cover this, but it won't cover that, so I have to do this, but I'd rather do that." Things like that, individual things that it covers or don't covers, and you'd have to pay for it merely out of the funds of one state. Could you do it?

Senator Gustavo Rivera: Yes, and matter of fact, let's just back up here for a second. You are correct that money is not unlimited. As a parenthesis, there is a lot of money that we're currently not having in revenue in the state, and we need to tax the wealthy to do it. Hopefully, we'll get to that in a second. To go back to this, we're talking about as far as creating a single-payer system in the state of New York, what we really have to think about is all the ways in which the current system is incredibly expensive and wastes a lot of money, but not on actually providing care. Moving away from a system in which has networks, premiums, copays, et cetera, in which again, healthcare is not a commodity, actually saves us money. Why? Because number one, we can actually take the entire State of New York and put it into one risk pool, if you know how insurance plans work, and this will not be an insurance plan.

In this case, if you have all of the entire state in one risk pool, that's number one, number two, you're able to negotiate on behalf of the entire state for drugs. Drug prices will actually become lower because you can negotiate when you're purchasing for the entire state. Third, you guarantee primary care to everybody. Therefore, you identify people that have chronic conditions, you have people not going to emergency rooms, which is incredibly expensive and certainly is not a healthy thing for people to do. Most of all, you get rid of administrative costs that are currently eating up so much of the healthcare dollars. Yes, this is a system in which we have a world in which money is not unlimited, but if we move towards a system which is single-payer, we actually will save so much money that the system will provide better care and will actually provide it for less money because we take the profit out of the equation.

Brian Lehrer: There would still need to be Prescription Drug Formularies, things that are covered, things that aren't, certain kinds [crosstalk]--

Senator Gustavo Rivera: Yes.

Brian Lehrer: Right?

Senator Gustavo Rivera: Yes, and that should be [crosstalk]--

Brian Lehrer: Procedures that are deemed cost-effective that will be covered or not covered, that kind of thing?

Senator Gustavo Rivera: Certainly, and there's actually some of this that we already do. We do this in Medicaid right now.

Brian Lehrer: Sure.

Senator Gustavo Rivera: Basically, which by the way, as an example, Medicaid currently has health care coverage for long-term care, which is something that we are including in the New York Health Act, so it'd be an included benefit, which is not necessarily what most people who can afford insurance products who don't have Medicaid actually have. We will actually have a better product that costs less money because once again, I cannot underline this enough, taking the profit motive out of healthcare. It is an obscene thing, for example, we're dealing with medical debt right now. I passed a few bills last year, was thankful for the governor for signing a couple of those bills, and I have a couple more that I'm fighting on this year because those two words, medical debt, it is an obscene thing that they're next to each other, but because we have a system in which profit motive is at the core of it, then such things as medical debt exist. We need to move away from that.

Brian Lehrer: Listeners, we can take your phone calls, pro or con or a question about a single-payer health care system for New York State, which is being considered by the state legislature right now. The sponsor of the bill is our guest New York State Senator Gustavo Rivera from the Bronx. He's also the chair of the Senate Health Committee. 212-433-WNYC, 212-433-9692, or tweet @BrianLehrer. Can you put some basic dollar figures on the cost of the whole thing for a year? The whole New York State budget is 200-something billion dollars per year, and already a very large share of that goes to Medicaid. What would this cost in addition, and how would you pay for it?

Senator Gustavo Rivera: Well, first of all, we would pay for it with a graduated assessment, so that means a tax based on ability to pay. You have a system in which we have to focus on the money that we would be saving. Yes, indeed, it would be an expensive proposition, but this is an investment in the health of people in New York state. Now, certainly, right now if you take all that is being paid in Medicare, in Medicaid, and in private, what would you average payout from the copays, the networks, the premiums, et cetera, then certainly we are already talking about an insanely expensive system that doesn't produce the results that we need, which is better health for people. This is what we have to focus on because yes, it is an expensive proposition, but what we have right now is even more expensive. When we take the profit motive out of the picture, then we can actually talk about how we keep people healthy.

That is not in the interest of insurance companies. Insurance companies are not in the business of keeping you healthy. They're in the business of keeping your money. Whether it's a couple of hundred billion dollars, which is certainly what it is right now, we would be saving an enormous amount of money, cutting down administrative costs, providing primary care to everybody, therefore, eliminating the need for a lot of folks to go to emergency rooms unnecessarily. We would be able to negotiate for drugs on behalf of the entire state of New York. All of this would actually save billions of dollars.

Brian Lehrer: What would the top line dollar figure be, or I should say bottom line dollar figure be for the state in the first year that this is in effect?

Senator Gustavo Rivera: I don't have a number [crosstalk]--

Brian Lehrer: How much money do you have to raise?

Senator Gustavo Rivera: I don't have a number for you at this moment. There's different analyses that exists out there. There's one that was done by the Rand Corporation a couple of years ago. I wish I had that number in front of me. It is not a small number. For what I would ask you and all of your listeners to think about is the system that they have right now. What is it that you have to go into your pocket to put as far as premiums, as deductibles, where you have to stick in network to be able to get any type of service, the decisions that are made by your insurance company about what is covered in what networks you are in and what you're not. You might be going to a doctor all your life, and from one day to the next, the insurance company decides that that doctor is no longer in the network. Why? Well, who knows?

We are actually having some conversations about what we call network adequacy and whether they're actually not meeting the standards that the state sets. Those are the things we have to focus on. If you're paying deductibles, if you have to meet deductibles, if you have to pay premiums, if you have to remain in network, if you have to have particular copays, all of those things, we want to eliminate that by simplifying the system and having a graduated assessment that is a taxed based on ability to pay. Rand, by the way, and I found the number here, put it at 139 billion a year. Again, I would ask you to think about how much we spend now. It's over $200 billion when we're thinking about all the premiums, the copays, the out-of-pocket costs. We want to eliminate all of that, eliminate the profit motive, and making sure that we focus on the health of individuals. That is the [crosstalk]--

Brian Lehrer: One more follow-up on that before we take some listener calls. Back in 2011, Vermont became the first state to sign a single-payer health care system into law, and it failed. It failed for a few reasons, but basically because of the cost of health care itself, then Governor of Vermont, Peter Sumlin, told the Washington Post at the time, "What I learned the hard way is that it isn't just about reforming the broken payment system. Public financing will not work until you get costs under control." Did you learn anything from the failed experiment ing Vermont in particular, and if it failed there, why would it work here?

Senator Gustavo Rivera: Well, first of all, it passed there. Ultimately, the switch, so to speak, wasn't flipped by the governor. He pulled the plug on it before it actually went into effect. The reality is that Vermont and New York are very different states. The revenue that we could generate here by having a graduated assessment, as I said, based on ability to pay far outpaces what actually Vermont would've been able to do. Lastly, we actually have been far more thoughtful about what we need to do in this state to be able to achieve this. We've been thinking about this for a long time, and we also want to seek a federal waiver, which is not necessary, but certainly would make it easier for us to be able to do. What we learned from Vermont is that they did not have the capacity to do it. I believe that New York does. I believe that New York has the right tax bracket system to be able to do it, has the right population to do it, and ultimately, this is what I want to leave every listener with, we must, I say again, we must move towards a system in which health care is not a commodity.

The system that we have right now is completely unsustainable because if you are wealthy, you get access to whatever you want. If you're middle class, if you're poor, you do not have access to the same things. Why is it that we continue to accept this as the norm? Why do we think that this is the way that we need to do it? The answer is to move away proactively and aggressively to make sure that we can demonstrate to the country that it can be done. If New York needs to lead, this is exactly the place where it needs to do it.

Brian Lehrer: Michael in Bay Ridge, you're on WNYC with State Senator Gustavo Rivera, Chair of the Health Committee. Hi, Michael.

Michael: Hello. Good morning. I'm very appreciative of the fact that you have the senator on the program. I am a UFT, United Federation of Teachers retiree. I'm very active in the fight against Medicare Advantage and a supporter of the New York Health Act. On two very recent occasions, one being last week, the other shortly before that at a public meeting with President Michael Mulgrew, he was asked about the New York Health Act, the UFT supported the Health Act in resolutions not so long ago, has now reversed that, but his comment to the audience was that the New York Health Act would blow a hole in the state budget. I'm very concerned to hear from the senator. I think he has been speaking about the financing of this bill, but in order to win labor to support this bill, I think that issue really has to be addressed with some nuts and bolts and how this in fact will help New York State and not blow a hole in the budget. Thank you very much.

Brian Lehrer: Thank you very much. Well, interesting. If his facts are right, that you don't have the support of the president of the UFT, at the same time that they're fighting tooth and nail against the city tracking them into a private Medicare Advantage plan rather than government Medicare.

Senator Gustavo Rivera: I want to make a couple of quick points here, and I thank the gentleman for chiming in. To everybody who is a union member in the entire state of New York, or anybody who is listening right now, you know that in every single negotiation that your union has ever had for your contract, the main issue has been health coverage. What I am proposing is a system in which you will no longer, I repeat, you and your union will no longer have to negotiate for health care because it will be guaranteed to you as a resident of the state of New York.

What I'm saying, certainly, and he is correct, we don't have the support at this point of the UFT, from President Mulgrew or the UFT, and we're working on it. I remain open to having conversations with everybody.

The hole in the budget, I don't believe that that is accurate because as I stated earlier, moving away from a system in which we have healthcare as a commodity will actually make the system cheaper as a whole. The overall budget will grow, but we'll spend less on our healthcare system. Bottom line, what I want to just repeat to everybody, if you're in a union, right now, you are negotiating, you are giving up your raises, you're not putting money into college funds, you're figuring out what your health premiums are going to be, you're going to figure out what your copay, et cetera, is. I want to make it so that you will never have to negotiate for that again, and it will be a better system for you, for every single board, for every single union member, and for every single New Yorker to have a better system with a higher floor for everybody.

Brian Lehrer: Here is Elizabeth in Manhattan who says she's a nurse. Elizabeth, you're on WNYC. Hello.

Elizabeth: Hi, good morning. Thank you for having this conversation. Brian, you made a comment earlier about Medicare and what's covered and not covered and those issues, but I think that's the thought that many people have. That's misinformed because in fact, those barriers that you talked about, Medicare is really the barriers we have with private insurance companies. The reason I noticed is I do the authorization approvals for people in the rehab unit. In order for them to go to other services, we need to get pre-authorization for them. That's always with Medicare Advantage, which is privately funded and not straight Medicare A and B. Just to make a clear understanding, it is much easier for our healthcare system to navigate through straight Medicare A and B and state Medicaid.

They're the easiest to deal with in terms of my end because we don't have to go through the loops and hoops to get authorization. Even when you talked about formularies, those barriers are with private insurance already. Just to attribute those barriers to Medicare A and B I think is really incorrect. My concern as a nurse is they have all this massive advertising for Medicare Advantage. In fact, it's not Medicare Advantage, Medicare disadvantage. That's my personal view and my professional view having worked with all of these insurance companies.

Brian Lehrer: Are you ready to deal with the state of New York as the single provider?

Elizabeth: Absolutely. All the way. I'm already there. I've lived in countries outside the United States where they have a single-payer or a state-sponsored healthcare system. Even as a foreigner where I had to use those services, it's so much easier. I had to get an ultrasound in Italy once. I went and I said, "Where do I pay the bill?" They said, "Oh no, you don't have to pay a bill." It's like, no, we're not going to bill you. That's built into their system. They provide health care for people who need it. It's built into their system. I didn't get a bill for it. It happened in Canada.

Brian Lehrer: Thank you so much. I appreciate your call. Senator [crosstalk]--

Senator Gustavo Rivera: Two quick things I want to [crosstalk]--

Brian Lehrer: Go ahead, yes.

Senator Gustavo Rivera: Number one, the reality is that many people don't see the holes in the current system until they are in crisis. When they're in crisis, the system doesn't work for them because ultimately, it is built around profit. One thing that I want to also address is, am I dreaming of unicorns here? Am I dreaming of fairy tales and lands on the other parts of the sea? No, I am not claiming that there is perfection to be found on the other side of this bridge, but regardless of that, what I'm saying is the state is a far more accountable entity. For all its imperfections, it is a far more accountable entity than private companies that are in it for profit. Now, considering I beat a guy 13 years ago who then served six years in federal prison for stealing public money from a Medicaid clinic that he owned in the South Bronx, I certainly know about my fair share of bad dudes, bad ladies, and bad everybody in state government.

However, I would argue that having a system in which it is accountable, it is a publicly-owned system, we actually will have far more access to it. As Gottfried would say all the time, this is a system that is meant to take care of all of us. Therefore, if it's taking care of the governor, it's taking care of me, if it's taking care of all of my constituents, we're going to make sure that that system actually functions. That's ultimately what we're talking about. Even with its imperfections, I believe that moving away from a system in which private companies that are for-profit are the ones that determine whether you get care or not is a far better proposition [inaudible 00:24:19] [crosstalk]

Brian Lehrer: By the way, who are the uninsured in New York state right now? I hear your argument is much broader than covering the remaining uninsured people in New York State. It's going to be better for the people who are insured as well, you're arguing who are sometimes nickel and dime to death because it's not nickels and dimes, it's more than that for copays, premiums, and other things where you can be put into financial stress because of a health crisis, even if you do have insurance, but I've read that a third of the state now is covered by Medicaid since the Obamacare expansion of Medicaid eligibility, a third of the 20 million people in New York State covered by Medicaid. I think that doesn't even include the senior citizens who are covered by Medicare, also government insurance. Then, a lot of other people have private insurance of various kinds. Who's left out of the current system?

Senator Gustavo Rivera: The people that are left out mostly are immigrants. We're talking about folks that are undocumented and folks that are underinsured. Roughly maybe 245,000 New Yorkers. There's 245,000 that are uninsured because of their immigration status. I believe that as an important step in moving towards universal health care, not universal insurance coverage, because you are correct, my point is much broader, we need to move away from insurance companies period. However, in the steps in moving towards that, it is the reason why my priority in this year's budget, one of my priorities, is coverage for all. The notion that we can cover undocumented folks, like 245,000 of them, which are currently not included in the essential plan, extend the essential plan to them.

By the way, hopefully, the governor who's maybe listening, or if her folks are listening, I would encourage them to go and get a federal waiver, which we can, which would make it so that the state would not have to pick up this cost. Matter of fact, might save us money. As opposed to spending almost probably about $500 million a year in emergency Medicaid as we are doing today, we could actually save hundreds of millions of dollars if we seek a federal waiver and get coverage for all. That is one of the things that we are doing. Again, it's a step in the right direction.

Brian Lehrer: Last question. Off-topic actually, but related because you just brought up coverage for undocumented immigrants, in budget season in Albany right now, Mayor Eric Adams says his number one priority from Albany in the budget is a billion dollars to help with migrant resettlement. What's your position, and do you think it'll get through?

Senator Gustavo Rivera: I hope it does. Listen, as many disagreements as I might have with Mayor Adams, I think it's important that we give resources to the city so that we can make sure to welcome these folks. We'll just say that, talking about things that are obscene, the way that these human beings are being utilized as a political football on behalf of these terrible humans, governors of other states that are just sending these folks here on some-- it disgusts me. I am glad that the state and the city are stepping up. The state needs to do more, and I'm hoping that it does during this budget process.

Brian Lehrer: State Senator and State Health Committee Chair Gustavo Rivera from the Bronx, thank you so much for coming on and talking this through with everybody.

Senator Gustavo Rivera: A pleasure to be with you, Brian. Hope to do so again soon.

Brian Lehrer: You bet.

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