With health insurance premiums climbing across New York, some lawmakers are once again pitching a familiar “solution” — scrap private coverage and put the state in charge of everyone’s health care.
More than 30 members of the state Senate are beating the drum for the New York Health Act, which would force every resident into a single, government-run health plan. The measure is currently sitting with the Senate Health Committee.
It’s a sweeping promise. It’s also a fiscal and medical gamble that New York can’t afford.
The bill has floated around Albany for more than three decades. Former Assembly Member Richard Gottfried is its legislative godfather. Now retired, Gottfried and several allies are once again insisting — this time in the pages of an academic journal — that single-payer is the “only sensible and realistic” option.
Realistic? Hardly.
A 2018 RAND Corporation analysis of an earlier version of the New York Health Act found that it would require $210 billion in new taxes — in 2031 alone. That’s more than the state currently collects in total tax revenue.
Working-class New Yorkers would not be spared. RAND projected that those earning less than $27,500 would have to pay a new 6.7% payroll tax. Middle-income folks would face a new 13.4% payroll tax — on top of what they already pay.
High earners, who already shoulder a disproportionate share of New York’s tax bill, would take the biggest hit. Those making more than $141,200 annually would face a new payroll tax of 20% by 2031. And they’d face new taxes on nonwage income approaching 18.7%.
The Empire State already has the highest tax burden in the nation. These taxes would add to it.
The consequences would be nothing short of catastrophic.
If just 0.5% of the wealthiest New Yorkers responded to these tax hikes by moving elsewhere, RAND forecast that state officials would have to raise marginal tax rates to nearly 30% for the lowest-income folks — and an eye-popping 88.4% for high-earners — to keep the system solvent.
So much for “free” health care.
New York is already losing residents to lower-tax states like Florida. Single-payer would only accelerate the exodus.
But the economic shock is only half the story. Single-payer systems don’t just raise taxes. They ration care.
In Canada, patients waited a median of 28.6 weeks in 2025 for specialist treatment after a referral from a general practitioner, according to the Fraser Institute. The median wait for an MRI in Canada was more than 18 weeks.
In some provinces, total waits for specialist treatment stretched past a year.
In England, more than 7 million people are on hospital waiting lists. Emergency departments forced half a million patients to wait 12 hours or more for a bed last year. “Corridor care” — the euphemism for treating patients in hospital hallways — is commonplace. Some patients are dying while waiting. The Royal College of Nursing has described it as “a form of torture.”
When government sets the budget, delays become a cost-containment tool.
New Yorkers are understandably frustrated with rising health costs. But replacing private insurance with confiscatory tax hikes and a sprawling state bureaucracy will not make care cheaper or more accessible.
Indeed, the New York Health Act is neither sensible — nor reasonable.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Follow her on X @sallypipes.