Single-payer health care is dead in California until these things change
Decent review of recent California Single Payer -- Made better by my commentary
Feb. 2, 2022Updated: Feb. 2, 2022 7:01 p.m.
This should have been the year that single-payer health care legislation passed in California. The pandemic exposed how our current system disproportionately harms the weakest and poorest Californians. Democrats hold a two-thirds majority in the Legislature, and for the first time, the state is led by a governor who campaigned on his support of single-paye
Instead, at the last minute before a legislative deadline this week, the author of single-payer legislation pulled the bill from consideration. Assembly Member Ash Kalra, D-San Jose, didn’t have the 41 votes necessary to pass it out of the Assembly, and it wasn’t even close: Kalra said they were “double digits” short of passage. Kalra doesn’t plan to bring it back until next January — if there is a friendlier Legislature.
“It was going to die in the Assembly, and I’m incredibly hopeful that a new wave of legislators will be enough to get it over the goal line in the Assembly,” Kalra told me on an upcoming episode of the “It’s All Political” on the “Fifth & Mission” podcast.
He’s being optimistic.
Single-payer isn’t just dead for this year, it is dead for the foreseeable future unless its supporters can explain it better we have very good “explanations”, descriptions and policies. Yes we are drowned out by the self-serving, well-funded lies, misinformation of those who continue to outrageously profit from the current non-system. This article is much appreciated—but we need many more like it, that are willing to tell the truth on policy and politics of Single Payer — starting with winning over people who, in theory, should be with them, like organized labor, Gov. Gavin Newsom and Kalra’s fellow Democrats. Supporters would have to move the position of and/or elect at least 10 more progressive legislators this year to replace the current batch.
That’s a big lift, even on the left coast. But without more progressive legislators in Sacramento, single-payer is doomed. While its supporters are passionate, vocal and well-organized, they’re no match for the deep-pocketed interests aligned against it. Health care is one-fifth of California’s economy and single-payer represents an existential threat to the insurance companies and hospitals that profit from it. Addressing campaign finance reform and keeping the vested interests from buying executives, legislators and their votes would be helpful in this review.
And if politically deep blue California — the world’s fifth-largest economy — can’t pass single-payer, the United States won’t follow.
“We’ve been talking about single-payer in California for a lot of years, and it hasn’t happened,” said Larry Levitt, a health policy expert and executive vice president of the nonpartisan Kaiser Family Foundation think tank. “Something different has to occur for it to get over the finish line.”
Here is what has to happen for single-payer to become a reality:
Better explain the unknown: Polls have consistently shown that a majority of California voters support single-payer. But advocates still have trouble countering the propaganda and convincing people — from employers to state legislators — that while they will pay more in taxes under a single-payer system, they will ultimately save money.
“A single-payer plan is kind of nirvana for patients: Go to any doctor, any hospital, no premiums, no deductibles, no co-pays. That sounds like exactly the kind of system many patients would want,” Levitt told me. “The problem is that that system doesn’t exist in the U.S. now. So you’re asking people to take on faith.” Though whole countries—like Canada and Taiwan—serve as examples, the closet we have to it here, for those that qualify, is Traditional Medicare and the Veterans Administration. Both of those, of course, while being far better than any corporate insurance, face their own problems. Many of which are created by those same deep pocketed powers that be that want to make more and more profit out of healthcare.
The business community doesn’t work on faith. It wants predictable fiscal outcomes — like knowing for certain that employers would be saving money. Advocates proposed funding the program by increasing payroll and sales taxes for large businesses and bumping the payroll tax by 1% for those who earn more than $49,900. It also proposed raising taxes on high-income Californians.
Passing the measure would have cost California $314 billion to $391 billion annually, according to an estimate prepared for the Legislature. That’s more than Newsom’s proposed state budget of $286.4 billion.
It is challenging to explain in simple terms how savings materialize on the back end of that. You could start by more accurately presenting the fiscal situation.
For example, the report on healthcare financing undertaken by the Governor’s Healthy California for All Commission demonstrated that already committed state and federal public funds account for $250 billion and that the difference that would need to be raised amounts to less than individuals, families and businesses are already paying in total health spending. The same report said that expenses in California under a single-payer system is expected to be $51 to $88 billion less than under current policy in 2031, for a cumulative savings of $323 to $496 billion over 10 years.
“It was rather shocking to see the sort of tax increases that would have to take place,” said Preston Young, a policy advocate for the California Chamber of Commerce, which led a campaign to describe the bill as a “job killer.” “That caused a decent amount of discomfort and pain amongst our members. That money has to come from somewhere, and naturally, it’s going to come from increasing your taxes.”
The chamber, backed by 122 business and medical organizations it marshaled, prepared to target moderate Democrats who supported the measure in this election year. The moderates blinked. How about countering with the facts from spokespeople supporting SP?
Unify labor: The California Nurses Association long has been single-payer’s most vocal advocate. And the 2.1-million member California Labor Federation officially supports single-payer.
But, as Kalra conceded, “There’s still work to do with our friends in labor and the building trades.”
While a number of unions backed the bill, Kalra said, “There are certainly a number of unions that do have questions and concerns, and this does allow us more time to try to get them on board.”
Zenei Triunfo-Cortez, president of the California Nurses Association, said, “We will continue to talk to them, educate them on what we are trying to accomplish here. ... It will be all about massive education, organizing and outreach.”
Levitt said parts of organized labor aren’t as full-throated in their support because “some unions represent workers with very good benefits and are reasonably happy with the current system. There are also unions that represent workers more left out of the current system, and the only way they’re going to get really good health benefits is with something like a single-payer plan.” And if it weren’t already obvious—the pandemic has underscored the insanity of tying healthcare insurance to employment.
Persuade Newsom to lead: Newsom earned the nurses union’s endorsement before his 2018 gubernatorial campaign largely because he loudly supported single-payer.
But Newsom was silent on Kalra’s bill.
Kalra told The Chronicle that “I definitely think that it was harmful to distance himself from single-payer health care, and there’s no doubt that I think we would have had better success and a better vote count, frankly, if there was support from the governor.”
Last month, a top nurses union organizer called Newsom a flip-flopper for his silence. This week, nurses union leader Triunfo-Cortez deflected a question about Newsom.
“If anybody is willing to work with us and be willing to stand up against the insurance industry and corporate health care, of course we will work with them,” she said. “But we will not stop, and we will not realign our agenda just because of someone’s political career.”
Levitt said the movement needs a political leader of Newsom’s stature to succeed.
“Single-payer had the best chance in quite a while in California with a governor who supported it during the campaign,” Levitt said. “But the governor has not taken on single-payer as a priority issue while in office.”
Should Newsom be re-elected, as expected, he will not have to worry about taking an unpopular position on single-payer in his second term. Of course, he may be reticent if he has his sights on the White House down the road. Granted it is still a risky move, but, being the governor who brought Single Payer to his state would be a powerful reason to vote for someone .
End progressive infighting: The bill’s collapse detonated a blast of infighting among its progressive supporters. The nurses union blasted Kalra for pulling the bill, which it said gave “cover for those who would have been forced to go on the record about where they stand on guaranteed health care.”
Before the vote, news leaked that the California Democratic Party’s progressive caucus leader promised to block endorsements from whomever opposed the bill. After the vote, Assembly Speaker Anthony Rendon, D-Los Angeles, ripped Kalra for pulling the bill, saying he would have voted for it.
Kalra tried to tamp down the fissures, as he has throughout the arduous months that he’s worked behind the scenes to get the measure to the Assembly floor. The progressive caucus’ missive did not “necessarily hurt the cause, but it didn’t sway anyone” to support it, he said.
Kalra said he would be willing to lead the charge again next time, too, if single-payer allies support him.
“My goal is to get single-payer health care in California. Whether I get credit for it or my name next to it is not of concern to me,” Kalra told me. “What is a concern to me is successfully getting the votes to pass it in the state Assembly, in the state Senate and get it to the governor’s desk.”
Joe Garofoli is The San Francisco Chronicle’s senior political writer. Email: jgarofoli@sfchronicle.com Twitter: @joegarofoli
