Universal coverage in California is a better bet than single-payer


After all the fighting over single-payer health care legislation, the author thankfully killed the bill himself. It was smart – the only possible move that made sense.

Had he pushed for a vote in the Assembly, the measure would have gone “in flames,” Assemblyman Ash Kalra, D-San Jose, told angry supporters on a Zoom call after letting Bill die peacefully.

He hoped to leave open the possibility of a resurrection next year in a new legislature.

He didn’t tick off many Democratic lawmakers by forcing them to vote “no” or abstain on the single-payer issue, which has become a holy grail for Democratic leftists — or so-called progressives.

If the outcome seemed close, putting lawmakers on the spot would have been fair game. But Kalra says the measure, AB 1400, would have failed by “double digits” – despite only needing a simple majority of 41 votes and Democrats holding a supermajority of 56 seats.

But the California Nurses Association, the bill’s zealous sponsors, wanted to take the names and kick the ass of Democrats who voted against single-payer. The politically active group intended to impose sanctions at election time.

After the non-vote, the union said it was “particularly outraged that Kalra chose to simply give up.”

NAC President Zenei Triunfo-Cortez told me that more than 300 AB 1400 supporters were watching the meeting live on the big screen, waiting for the debate and the vote.

The California Democratic Party’s Progressive Caucus has also threatened to withhold endorsement from Democrats who voted against single-payer.

The only logical answer was therefore to cancel the vote when the bill was doomed to a miserable failure.

Kalra explained to me, “Going down to double digits, it would have done irreparable damage.”

Many lawmakers who may not have voted for the bill could still be persuaded to support future legislation, Kalra said.

But once a bill is blown, he noted, “It’s harder to get them on board. They will be exposed. And they will have been re-elected without having voted for the single payer. This hardens their position.

Kalra said he expects at least 15 new Assembly members next year and thinks many will be open to voting for a new single-payer bill.

But it’s hard to imagine a more liberal legislature than this, with Democratic supermajorities in every house.

A big political problem for the single payer is that it is a single payer.

And it’s not Medicare for everyone. It’s health insurance for nobody.

It’s called single-payer because a single entity — the state government — would pay health care providers. Insurance companies would be left out.

Californians would transition from their current coverage — whether private, federal Medicare or Medi-Cal for the poor — to a new state-run system called CalCare under Kalra’s bill.

The goal is to cover everyone and reduce health care costs by eliminating private insurance benefits and negotiating lower provider fees and drug prices. Under CalCare, there would have been no premiums, copayments, or deductibles.

But that would have required the largest state tax increase in history, estimated at $163 billion. It would have cost up to $391 billion a year. And Washington should have given Sacramento all the federal Medicare and Medi-Cal money it now spends in California.

All of this is mind-boggling.

But here’s a simple statistic that’s a huge barrier to public acceptance of any state-run single-payer program: There are more than 1.6 million Californians on Medicare. And they seem reasonably satisfied.

Medicare beneficiaries are mostly people aged 65 and over. They are high-propensity voters. And those I know wouldn’t like the state interfering with their health care. They would be nervous about being forced into a Sacramento-run system, which tends to fumble the ball.

“Medicare is a good program. That’s why people use “Medicare-for-all” as a slogan “for universal coverage,” says single-payer proponent Anthony Wright, executive director of Healthcare Access California, an advocacy group.

It is also virtually impossible to pass legislation for this revolutionary without considerable promotion and pressure from the governor. Gavin Newsom did not participate in that failed fight, despite running for governor as a strong single-payer supporter. Since then he has apparently been indoctrinated in political realism.

Newsom is single-handedly moving toward universal health care by proposing that all qualified low-income Californians be covered by Medi-Cal, regardless of immigration status. The last undocumented age group not on Medi-Cal is 26-50.

The governor has also established a commission to develop a broad plan for universal health care. The panel hopes to report in April.

Single payer seems out of reach. But universal coverage is close.

Meanwhile, Kalra saved everyone from wasting time and needlessly brawling.

George Skelton is a columnist for the Los Angeles Times.

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