new york state of health

New York State Moves Closer To Single-Payer Healthcare

Columns Insights

What Does Single-Payer Healthcare Mean For People, Companies and Providers?

By Michael FidlowMichael Fidlow

Bernie Sanders warmed us up for the possibility of a national single-payer health-care system but now the topic is on the front burner in New York.

For the past four years, the New York Health Care Act passed in the democrat-controlled New York State Assembly while Republican senators blocked it. Prospects for the passage of a single-payer health-care bill have increased substantially since voters in the mid-term elections flipped control of the state Senate from Republican to Democrat. Reportedly, there is now a majority in the State Senate that is on record in support of the legislation.

But the final decision may rest with Governor Cuomo, and there is no telling yet which way he may lean. In the meantime, expect to hear a lot of debate on the subject.

So what is single-payer? Single-payer national health insurance, also known as “Medicare for all” is a system in which a single public or quasi-public agency controls health care financing, but the delivery of care remains in private hands. No issue is more important to voters than the future of healthcare. In fact, NBC News and The Wall Street Journal found that healthcare was the number one issue in a poll of potential voters.

Let’s take a look at what a single-payer system means for single-payer beneficiaries, providers and employers.

It is clear that we should educate ourselves to the fullest extent and have honest discussion on this issue.


A single-payer system delivers health care with $0 co-pay, $0 deductible, $0 RX plan. There will be no out-of-pocket costs when accessing benefits. Single-payer systems eliminates the need to rely on employers for health care. People will have access to the system, whenever they are ill, and no matter what their illnesses are.

Providers will have plenty of new patients and will not have to compete for business.  They won’t have to hire extra staff for billing various insurances as they will have to address only one carrier. This consolidation would make referrals obsolete, streamline pre-authorizations, and perhaps create a centralized data system for all NY patients.

Employers will no longer go through a difficult renewal process each year when deciding on benefits for their employees. Those who view benefits as an intolerable one-third of payroll and cannot attract quality employees without offering top of the line benefits, will eliminate this concern. Employers would no longer be saddled with COBRA, and other expensive mandates.


Here’s the big one: We have no experience with how a single-payer system will affect our taxes, and it is difficult to know which prognosticators to believe. There may be longer waiting times at the doctor’s office, ER, and/or Urge-Med centers, if we base our presumptions on socialized healthcare in European countries.  Also, those in need of care will be unable to go out-of-state without paying for it.

Providers and/or hospitals may not be able to afford lower Medicare-type reimbursement payments. They may not be fully prepared to handle a burgeoning patient load and deliver quality medical care. Providers may be tied to thinking “inside the box” when it comes to progressive treatments in medicine. These restraints might discourage physicians from practicing in the state.

Employers will be taxed for benefits but would be unsure as to how would their share be doled out versus their competitors. And brokers will no longer continue to play an important role when the insurance industry is set up as a government-controlled entity.  Clout is lost by all when dealing with pre-authorizations and pre-admissions versus one carrier.


As a member of the National Association of Health Underwriters (NAHU), it is clear that we should educate ourselves to the fullest extent and have honest discussion on this issue. It is easy to argue healthcare should be guaranteed for everyone, and that it is a fundamental human right, not just a privilege. That said, New York must tread carefully because too much upheaval at one time can backfire. Please ask yourself the important questions on this debate as we barrel toward the 2020 elections. Guaranteed, healthcare will be a hot and hotly-debated topic.

Michael Fidlow is president of Strategic Employer Planning Group, LLC a group health benefits consulting firm for small companies in NY/NJ that employ 2-49 employees.