If some form of health care reform happens in Washington, then we in New York will have the opportunity to improve on it. If national legislation doesn’t happen, there will be an even greater need for New York to tackle health care reform.

Either way, this is a time to think about what values and social policy ought to guide reform. At the heart of the debate is the question: who should pay for health care?

It is not that difficult. Think about education. It’s a parent’s responsibility. But we demand that our government provide free quality education for every child. We figured out almost two centuries ago that education is a public responsibility. No one suggests that parents be required to pay a deductible and co-payments to send their children to public school, or have to prove they are low income to get a public school subsidy. We pay for education with broad-based taxes, roughly based on ability to pay.

Back then, when America decided universal public education is a government obligation, no one would have thought to apply that idea to health care. In those days, health care was little more than leeches. But health care has come a long way, and health care costs along with it. Unfortunately, our public policy has not.

Today, people who earn less or have health problems pay a far greater share of their income for health insurance and out-of-pocket health costs than people who are wealthier or healthier. We pay a high and regressive “tax” to insurance companies – premiums and deductibles they set – not based on ability to pay. Small businesses and people who buy insurance on their own pay a lot more.

Low-income people can get publicly funded health coverage. That’s fair. But fairness should apply to all of us. For the average working family, the cost of premiums, deductibles, and copayments, or the cost of health care if they are uninsured, can be a crippling burden.

For many things, we accept having different alternatives available to upper- and lower-income people – you can get by on cheaper food, cheaper clothing, and cheaper housing. But access to quality health care is a matter of life and death.

Some say: “This is America; you’re on your own.” I say: “This is America; we believe in community; we help one another. And some problems are so large that we demand that our government take some responsibility.”

What about individual responsibility for our own health? Well, parents have responsibility to raise their kids and homeowners to keep their home electrical wiring safe and the door locked. But we recognize education and public safety as human rights. They’re things we demand from our government; we as a community all contribute, and the cost is distributed, using the tax system.

Health care should be a right, not a privilege, and the cost should be fairly distributed. If we start with that principle, working out the details is really not that complicated.

For me, I think this means a system that offers health coverage like Medicare and Child Health Plus, but available to all of us, with public funding based on ability to pay. My New York Health Plus proposal (Assembly bill A. 7854, Gottfried; Senate bill S. 4884, Duane) would create such a system for New York.

 The legislation we can achieve this year might not get us there right now. But if we keep our values in mind, then what we enact will move us in the right direction.


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Richard Gottfried, a Democrat representing parts of Manhattan, is chair of the Assembly Health Committee.