I’m so disappointed in myself.
I should be 100-percent supportive of establishing California’s own single-payer system, in which the government uses taxes to pay everyone’s healthcare costs. Because all the best Californians are for it.
California’s next governor, Gavin Newsom, has made single-payer central to his campaign. America’s next president, California U.S. Senator Kamala Harris, is behind it. Good progressives – unionists, nonprofit folks, Democrats – have made single-payer their number-one political litmus test. Any officeholder who doesn’t support it faces recall and Twitter bullying.
I start thinking about money – I’m so ashamed! – and ask: Why doesn’t the single-payer legislation in California and in Congress explain how you pay for single-payer?
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So why do doubts keep springing to my diseased mind?
I confess that, in dark moments, I wonder whether single-payer is just a weapon that some politicians use against opponents. But how can I think such a thing when President-in-Waiting Harris recently assured us – as she cosponsored single-payer legislation to protect you from health insurance by making it illegal for your employer to provide it – that single-payer is “a nonpartisan issue”?
Now, sometimes I get cynical and wonder if it might be wiser to just build on the existing public-private system. And I think of the one-third of Californians, and the half of our children, on Medi-Cal, California’s version of Medicaid, a smaller version of single-payer in which the government pays for their healthcare. Still, they struggle to get care because there aren’t enough doctors and institutions to serve them.
Then I start thinking about money – I’m so ashamed! – and ask: Why doesn’t the single-payer legislation in California and in Congress explain how you pay for single-payer? Then I read estimates that single-payer healthcare in California alone would cost $400 billion, two-and-a-half times the size of the state general fund.
That gives me an anxiety attack, since raising taxes requires a two-thirds vote of the legislature, which can be challenging. Then I worry – I’m not proud of this – about my kids’ schools. The two big pieces of the state budget are education and health care, so when you see a big run-up in health spending, teachers get laid off and instruction time gets cut.
But then I get a hold of myself, and listen to Bernie Sanders (who like all Vermonters knows California deeply), and I stop worrying.
Because California’s schools already do fine with some of the lowest state funding levels in the country. So why would it matter if they’re cut further? Since everyone will be much healthier under single-payer, the teachers can teach more kids in less time, and the children will learn faster!
After listening to single-payer advocates, I’m sure that single-payer will save money, because all the dough we spend on insurance and pharmaceuticals will just be replaced by new taxes, and efficiencies will create some savings. (Don’t sweat the details). While there might be start-up costs, this is California – we’re rich! If the taxes don’t come through at first, we’ll run a Kickstarter. Or crowdsource it. Or make Mexico pay for it.
Since having those realizations, I’ve been totally behind single-payer – with the exception of one bad doubt bender. My trigger for that episode was the housing crisis.
I was reading about the massive state housing shortage when I saw that L.A. and San Diego Counties, beset by hepatitis outbreaks among their rising homeless populations, had declared public health emergencies.
I couldn’t avoid thinking: How can California’s leaders be promising pie-in-the-sky single-payer when they can’t provide Californians with the most fundamental piece of health – shelter?
But then I realized I was stuck in the past. Just because our systems for education and housing haven’t produced enough education and housing doesn’t mean that single-payer healthcare won’t produce enough healthcare.
Then it hit me: My doubts about single-payer are a form of illness – and thus a winning argument for single-payer.
Clearly, I’m sick in the head. And if there were a cure, I couldn’t afford it. So single-payer will fix me, and good.
Joe Mathews writes the Connecting California column for Zócalo Public Square. He can be contacted at firstname.lastname@example.org.