Single-Payer in California: Slowly, Slowly, Catchy Monkey
For now, California’s progressive politicians have judged single-payer as a bridge too far. But that doesn’t mean they’ve given up trying to take over health care. As my Canadian mother used to say, “slowly, slowly, catchy monkey” – or be patient.
On March 14, Assembly lawmakers released a report by two professors from the University of California, San Diego and a consultant that was commissioned by Speaker Anthony Rendon as part of the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage hearings that ended in February. The panel’s report promoted an incremental approach and a long-term vision to single payer health care. Two key issues to be resolved before implementing a single payer system are cost and getting waivers from the federal government so Medi-Cal and Medicare could be rolled into the single payer plan. The Nurses Union and other groups were very upset with the report’s findings. And, last week, a coalition of labor unions, community health organizations, immigrant rights groups, and single-payer proponents joined forces with Democratic politicians to support a package of bills and proposals that would bring California closer to single-payer health care. Below are some of the proposals:
- Create a “public option” government insurance plan that would, in theory, compete with private insurers to offer more options to consumers. The problem with this idea is that the government, thanks to taxpayer dollars, would undercut private insurers and further distort the market to the point where insurers can’t compete in California. What’s left? Single-payer health care and all the misery that comes with it.
- Create state-funded subsidies on Covered California. SB 1255 would add state subsidies to existing federal subsidies to help consumers purchase insurance on Covered California, the California exchange under Obamacare. This just doesn’t make sense. The government taxes Californians in order to subsidize their insurance policies. Why not just lower taxes so they can better afford insurance? The only winner here is the state bureaucracy middleman.
- Extending coverage to illegal immigrants with Medi-Cal. California already covers illegal immigrant children. Free health care for all illegal immigrants would only encourage more illegal immigrants to enter California from other states and abroad. The already growing wait times for the 13 million Californians on Medi-Cal would only get longer under this proposal. Emergency room use would continue to grow as it has since the implementation of Obamacare. Our generosity must be balanced with taxpayers’ ability to pay. California is already losing its middle-class tax base to lower-taxed states.
- Controlling rising health care costs. Angela Hart of the Sacramento Bee, reports that there are efforts underway to control costs by lowering prescription drug prices, capping payment rates to medical providers, and requiring health plans to limit the amount of revenue spent on marketing and administrative costs. Unfortunately, when the government interferes, the end result is more often higher health care costs, not lower.
- Impose a California individual mandate. As this is a tax issue, it would require a two-thirds majority vote to pass. The Trump Administration, backed by Republicans in the Congress, ended the individual mandate under Obamacare beginning January 1, 2019. Forcing Californians to buy individual insurance will only hasten outmigration to other states, particularly by small business people, entrepreneurs, and independent contractors who buy insurance on the individual market. California already ranks last in so many business surveys – the individual mandate will be another reason to avoid California.
Of course, nowhere during last week’s fanfare was there a serious discussion on how to pay for it all. Rough estimates show that the various proposals could cost up to $10 billion. Proponents including Anthony Wright, executive director of Health Access, said they would seek money in the budget but did not rule out proposing new taxes. Wright adds, “…this gets us closer to a ‘Medicare-for-all’ type system, and if the window of opportunity opens at the federal level, that means we’ll be this much closer to take the leap when it’s possible.”
Indeed. A leap to single-payer is a leap into the chasm of rationed, long waits, substandard care, at unfathomable cost.
Sally C. Pipes is the Pacific Research Institute’s President, CEO, and Thomas W. Smith Fellow in Health Care Policy. Her latest book, which was just published by Encounter Books, is “The False Promise of Single-Payer Health Care.”