California's "Medicare for all" bill goes before a key Senate committee today, the latest chapter in a long-running battle between universal health insurance supporters and business.

Senate Bill 810, introduced by San Francisco Democrat Sen. Mark Leno, would establish a California Healthcare Agency to run a single-payer health care system that would pool employer and employee payments. It would administer the money and negotiate rates with doctors, hospitals and other medical providers.

As a mammoth player in the industry, the thinking goes, a state-operated system would drive down medical costs and insurance premiums while improving access to care.

The bill doesn't establish any new taxes or fees, preferring to leave that for future legislation.

"If you want to have the most sane and inexpensive way to deliver health care," said Andrew McGuire, executive director of California OneCare, which is focused on organizing support for a single-payer system, "this is it."

Opponents say the bill would have the opposite effect and that Californians don't want government to get more deeply involved with their medicine.

"We fundamentally disagree with the two major premises of the bill: (1) government systems are more efficient than private business, and (2) a single-payer system would be less costly than the current private system," California Chamber of Commerce lobbyist Marti Fisher said in a letter last week opposing the Leno measure.

Federal numbers show that spending by individuals, insurers and government agencies in California amounted to $6,238 per resident in 2009, about $600 per person below the national average.

California, like many of the lowest-spending states, is demographically younger and has relatively high numbers of uninsured residents, researchers for the Centers for Medicare & Medicaid Services concluded. They also attributed California's relatively low Medi-Cal reimbursement rates for contributing to its low overall medical-spending ratio.

The fiscal impact of Leno's measure hasn't been analyzed, but the cost of a similar bill during the 2009-10 session was pegged at $200 billion annually.

The cost of that earlier measure would have been offset "to an unknown extent," the state analysis says, by redirected money currently going to private insurance plans.

A 2010 federal law already places insurance coverage requirements on individuals and businesses in two years, although those provisions are being challenged before the Supreme Court.

That law, the Affordable Care Act, is a damper on state efforts, McGuire said, "because it's allowed many folks in the Legislature to say, 'We don't need any other reform now. Let's let ACA play out and see how it works.' "

Still, because the federal law doesn't establish a single-payer system, Leno thinks there's plenty of room for California to act even though earlier efforts have failed.

Former Republican Gov. Arnold Schwarzenegger twice vetoed single-payer health insurance bills. Several other universal health care measures have died in either the Senate or the Assembly over the last decade. California voters in 1994 and again in 2004 rejected government-run health care initiatives.

The Senate Appropriations Committee is scheduled to consider SB 810 today at noon. If it clears a full vote of the Senate, it will move to the Assembly for more hearings.

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