De Blasio's NYC Care Plan: Neoliberal "access to care" vs. a socialist single-payer system

By NYC-DSA Healthcare Working Group

On January 8th, 2019 Mayor DeBlasio announced a new proposed program for changes to NYC's healthcare system that his administration has framed as a form of universal healthcare for every New York City resident. In reality, it includes minor reforms that will likely lead to some residents using more outpatient or preventive services, but does little to challenge the city’s racially and economically segregated, profit-driven healthcare system that continues to perpetuate inequality in healthcare outcomes.

The mayor’s proposal consists of two main parts: 1) investment in the managed care plan MetroPlus, which the administration is calling a “public option” for health insurance because it is accepted by the city's public hospital system, to increase plan benefits and enrollment, and 2) expansion of the use of sliding scale fees for primary and specialty care at public hospitals, with the expressed aim of targeting uninsured New Yorkers, including undocumented immigrants. Healthcare options for undocumented New Yorkers are confusing and limited, and addressing this disparity should absolutely be a priority. Undocumented immigrants can only qualify for insurance if their income is under the Medicaid limit and this insurance covers emergency care only. Paying for this emergency coverage is costly for the city and state, so this provides a monetary incentive to get more undocumented residents into primary and preventive care.

The ideology of this proposal is based on the concept of increasing “access to care”, as if getting someone’s foot in the door of a healthcare facility is an end goal in itself, or that enrolling in health insurance or being charged a sliding scale fee suddenly means that someone can get the care that they need. A main component of the proposal is an investment in customer service to help people navigate the process of getting healthcare, which acknowledges that the system will still be fractured and confusing enough to need this kind of assistance.

The US healthcare system as it currently functions extracts profit from people, who are considered customers, to enrich a small few, including health insurance and pharmaceutical companies. Since the profit motive also affects fundamental areas of our lives like housing, education, and the environment which greatly affect our physical and mental health, the fight for health justice means eliminating the destructive influence of the profit motive in these areas as well. The mayor’s proposal acknowledges that there are problems with the current healthcare system, and is trying to address them with minor changes in NYC on the city level, but it is clear that this is totally insufficient in the fight for broader health justice.

In NYC-DSA, we reject the very idea of health insurance, because insurance is a concept that should have no place in healthcare. We will accept nothing less than the equitable distribution of quality, comprehensive healthcare for everyone.  Our ultimate goal is a healthcare system where everyone has high-quality comprehensive care, including reproductive and long term care, that is free at the point of service; hospitals are publicly owned and operated; and drug patents and other medical R+D are public domain.  We fight for single-payer health care because it is the only achievable step towards a planned nationalized health care system that is fully divested from the profit motive.

This year, 2019, presents unique opportunities for DSA and single payer advocacy groups. We will be pushing for public hearings and floor votes on single payer legislation in the House of Representatives and the NY State Senate in order to set the stage to make single payer healthcare the decisive issue of 2019 and 2020. In this context, DeBlasio’s announcement appears as a little more than a desperate attempt to distract from the increasingly viable pieces of single payer legislation that are currently gaining popularity and legitimacy at both the national and state levels; it is the latest in a long line of efforts to obscure the fundamental class conflict that underlies our current healthcare crisis.