Capitol Journal: A state single-payer healthcare system? Nice idea, but it’s just California dreaming

California and New York become the latest states to consider single-payer health insurance systems as Congressional Republicans prioritize repealing and replacing the Affordable Care Act.


Voters want politicians to be bold. They disrespect timidity. And trying to push every Californian into a government-run healthcare system is certifiably bold.

The voters’ desire for boldness has a caveat, of course: They’ve got to like what the politician is being bold about.

We really don’t know how Californians feel about government-run universal healthcare. People haven’t been asked for a while.


The Public Policy Institute of California surveyed voters in January, however, and found that 54% opposed congressional repeal of the Affordable Care Act, or Obamacare.

But for generations, it has been the dream of many — mostly Democrats — to enact whatever you want to call it: “single-payer,” “Medicare-for-all” or “socialized medicine.”

Now, with congressional Republicans and President Trump trying to repeal and replace Obamacare, some Sacramento Democrats think they see an opening to finally adopt a California version of single-payer.

Under single-payer, healthcare costs are paid for by the government, rather than by private insurance. The healthcare itself is still delivered by private physicians.

Some version that would allow people to buy supplemental private insurance — call it “Medicare-for-all” — presumably could fit into the system these Democrats envision.

We really don’t know because they haven’t actually proposed anything. They’re promising details in two weeks. So far, they’ve just tucked the concept of single-payer into an essentially hollow bill, SB 562, by Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego).


The bill merely declares: “It is the intent of the Legislature to enact legislation that would establish a comprehensive universal single-payer healthcare coverage program and a healthcare cost control system for the benefit of all residents of the state.”

Yes, that means “all” — whether they’re in the country legally or not.

Medi-Cal, the state’s enhanced version of federal Medicaid for poor people, already covers children here illegally. But not their parents.

Lara told me that he mentioned to one kid that the Legislature had extended Medi-Cal to undocumented children.

“He said, ‘Thank you senator, but what about my mom?’” Lara recalled. “What about my dad? How do we get to healthcare for everyone?’”

With great difficulty, I’d say. And the same for enacting any single-payer system.

Dreams can be good. But this dream — especially with Trump and conservative Republicans controlling the national agenda — seems like wishful fantasy, even in deep blue California.


The envisioned policy long has made sense. Cut out the insurance industry profiteering and reduce healthcare costs. Perhaps eliminate co-pays and deductibles, as Lara wants to do.

Even Medicare-for-all would be better than what most people have today. Ever hear a senior seriously complain about Medicare? I haven’t.

Most industrialized nations have some sort of government-run healthcare coverage — either single-payer or a hybrid public-private system.

But good policy aside, there are two huge obstacles to a state going solo: financing and politics.

In California, it would cost the state tens of billions of dollars. Who’d pay for that? Business, which presumably would no longer need to provide employees with health insurance? Wage earners through payroll withholding? Medical providers? How much would the federal government kick in? Anything?

That presumably will be in the bill’s details. Good luck.

And how would this legislation ever get passed? The politics are daunting. The insurance industry would fight with all it has — meaning campaign money. So would many healthcare providers that historically have feared “socialized medicine.”


On the other side, the California Nurses Assn. is the bill’s chief sponsor. And that labor union has influence among liberals.

But nothing of this magnitude and controversy can pass the Legislature without a committed governor pushing strongly. And Gov. Jerry Brown hasn’t said a peep about single-payer healthcare since he was elected in 2010. Moreover, the normally cautious skinflint is not likely to commit the state to such a financial gamble.

No other state has a single-payer plan. Vermont did briefly, but scrubbed it in 2014 because of high costs and unpopular taxes.

The California Legislature passed a single-payer bill — sort of — when Arnold Schwarzenegger was governor, but he vetoed it.

Actually, it wasn’t a real single-payer plan anyway. It didn’t include any financing. That was to be passed later and required a two-thirds supermajority vote. No way.

Updates from Sacramento »


Democrats currently hold a supermajority in each house. But you can bet not all are inclined to vote for a tax increase. Possibly for highway repairs, but not for an untested, radical change in healthcare coverage.

“The time is right, the time is now,” insists Lara, who’s thinking about running for state insurance commissioner next year. “California can be the national laboratory for our country.”

“What everyone agrees on,” he adds, “is we need to have an alternative” to threatened Obamacare.

But many Democrats believe their best hope is congressional gridlock and the blockage of repeal.

“Perhaps I’m like Alice in Wonderland, but I really am hopeful,” says state Sen. Holly Mitchell (D-Los Angeles), the Budget Committee chairwoman. “There’s an amazing groundswell of people showing up all over the country fighting to retain the Affordable Care Act.”

What about single-payer? “I honestly don’t know.”

Not a lot of enthusiasm there.

She sounds like other Democrats who privately believe the focus should be on preserving what they can of Obamacare, which has pumped nearly $24 billion annually into California healthcare and halved the number of uninsured.


Bold is good. And it’s good some people are promoting universal healthcare. But whatever they call it, if there’s no funding it’s fantasy.

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