Kevin Cahill has probably forgotten more than you or I will ever know about the important, complex and vexing subject of healthcare policy. The Kingston assemblymember is a walking encyclopedia when it comes to systems of health care both domestic and international. He’s been immersed in the topic for more than 30 years.
It’s clear where he stands in the current seemingly endless debates. Cahill is and has been for his entire political career an unabashed supporter of a single-payer health system, sometimes characterized as “Medicare for all.” That was clear when he addressed a group of more than 100 supporters gathered outside the county office building in Kingston on Monday morning last week prior to a state legislative hearing on the sixth floor.
Parked on the Fair Street curbside was a truck with a massive mobile billboard carrying the message, “Single payer will hurt New York.” A single-payer healthcare system in the state would mean $10.1 billion in new taxes and cost 160,532 jobs, the billboard said.
A series of speakers including Cahill disputed the intrusive billboard. “Healthcare is a human right,” they said. “It’s also an economic necessity.” Healthcare bills are today the leading cause of personal bankruptcy in America.
The crowd was encouraged to start a chant, “They got billboards, we got people.” That was followed by “Everybody in, nobody out.”
Todd Schmidt, president of the Ulster County local chapter of CSEA, the civil-service union, said later in the week that his members were currently opposed to a state-based single-payer system, which he said would be very costly and would not improve on the benefits that his members enjoyed under collective bargaining agreements with the county government. There were occasions, added Schmidt, that the union had taken less money in negotiations because of the quality of these benefits. Though he was open to expanding coverage for the uninsured, he thought it unlikely anything would be offered that “would be as good as what we have.”
The Organization for Economic Cooperation and Development (OECD) provides the international gold standard for the gathering of information about how — and how well — the healthcare systems of various countries work. The OECD measures their performance by various yardsticks and publishes annual findings (Health at a Glance 2019 is the most recent). It provides as close as the world has to the common data base from which reasoned debate about international healthcare policy can take place.
What’s obvious is how varied are the national systems. These differences often reflect how the systems came to be and the variations in perceived healthcare needs in various countries.
That variety holds true in the various states of the United States, Kevin Cahill noted. Different states follow different models and have different experiences.
“There is no national consensus or even common experience from one state to another regarding health care,” Cahill pointed out in a communication last week. “Florida, for example, has long been a clinic-model state. Montana relies on remote health care. New York’s system is centered around institutional care through hospitals and nursing homes. The range of benefits and the nature of providers varies from state to state as well.” There are more than 50 healthcare delivery systems in the United States.
For Cahill, attacking healthcare problems through Albany is the more promising route. As bad as things are in Albany, this veteran state legislator thinks, they’re a lot worse in Washington. A national health plan created in Washington would be “so full of warts and gaps [that] we may wish it didn’t exist.”
Medicare for all would be the simplest and probably the most economical way to transition on a national level, Cahill said. Making the state the insurer of last resort for the uninsured (“the public option”) might be an acceptable solution. There are alternatives, though. “It’s important to remember that there is more than one way responsibly to address the issue,” he concluded.
That flexibility undermines the characterization by some opponents of Kevin Cahill as an ideologue. Cahill’s a politician, not an administrator. His decades of exposure to the varied ways different societies and different regions within societies deal with healthcare has taught him a thing or two. He has developed considerable expertise in threading the policy needle to address the aches and pains of a vast industry that accounts for one dollar of every six in the American economy. Despite an admittedly nuanced and difficult New York State political picture, he sees a leadership path for the state. For the 64-year-old Kingstonian, introducing universal health care to New York State is the opportunity of a lifetime.
“So strong is this propensity of mankind to fall into mutual animosities,” wrote James Madison in 1787 in Federalist Paper 10, “that where no substantial occasion presents itself, the most frivolous and fanciful distinctions have been sufficient to kindle their unfriendly passions and excite their most violent conflicts.”
Perhaps because it involves so many life-and-death decisions, the chaotic universe of American healthcare provides a fertile breeding ground for mutual animosities, whether at the national, state or local level. With so much at stake, interest groups are likely to be uncompromising. But the wise statesman knows that some compromise is necessary. “The friend of popular governments,” wrote Madison, “will not fail, therefore, to set a due value on any plan which, without violating the principles to which he is attached, provides a proper cure for it.”
Cahill, himself certainly no stranger to political partisanship, relishes opportunities to remind conservative opponents of occasions of their political apostasy. For the Kingston hearing, he found a good story from his own experience.
Arthur Flemming, Dwight Eisenhower’s Secretary of Health, Education and Welfare, a native Kingstonian buried in Montrepose Cemetery, favored a single-payer healthcare system. “Flemming told a group of mostly his fellow Republicans gathered at the Hillside Manor to celebrate the anniversary of the local hospitals that universal healthcare access and a national single-payer plan was an imperative, the same postulate he offered for the previous 60 years,” wrote Cahill. “I swear by the end of his speech even the staunchest of opponents was rethinking their position.”