As the state contemplates major changes as to how health care will be financed and delivered, California gubernatorial candidates have outlined their positions.
Lt. Gov. Gavin Newsom and former state schools chief Delaine Eastin, both liberal Democrats, are the only two to unequivocally voice support for creation of a single-payer health care system financed by California taxpayers and run by the government.
Other Democratic candidates said they too support the idea of single-payer, but expressed widespread concern over raising taxes to cover its projected $400 billion price tag, as well as future changes that would be needed to implement such a system.
Whatever changes to California's health care system state lawmakers seek, they'll face major financial and political questions.
Against single-payer, wants price transparency.
Republican businessman John Cox said the free market is the solution to rising health care costs and inadequate access. If elected, he said he'd push for cost transparency for all health care procedures and services. The idea is patients would be able to see upfront costs from insurers and hospitals before making any medical decisions.
"Payment is power," Cox said. "So we need to make sure that we have a truly free market, patient-driven, competitive health care system and that involves innovation. I'm talking about health care providers – doctors, hospitals, clinics – being competitive with one another and being transparent with their pricing so you can walk into an emergency room or hospital and ask how much everything will cost you."
Cox also supports efforts by President Donald Trump and the Republican-controlled Congress to repeal Obamacare.
"The Affordable Care Act said it was about affordable health care, but it was only affordable with government subsidies," Cox said. "You don't make anything more affordable by giving some people subsidies."
Opposes single-payer, wants more competition in the private market.
Republican Assemblyman Travis Allen says if elected, he'd deregulate health insurers and loosen the rules for selling insurance in California.
"The right answer is to open up our state insurance market to out-of-state companies to compete with Californians' business," Allen said.
He too backed efforts to scrap Obamacare, and he believes a taxpayer-financed system run by the government would bankrupt California.
"The right answer is to open up our state insurance market to out-of-state companies to compete for Californians' business," Allen said. "Anytime you eliminate competition, you're going to get ultimately higher prices and lower quality."
Supports creation of a universal, single-payer health care system.
"One thing single-payer is, is a radical departure from a multi-payer system. One thing it's not is more expensive," Newsom said in an interview with The Bee Editorial Board. The difference between me and a number of the other (Democratic candidates) is rather than telling you all the reasons it can't be done, I am committed to pursuing ways that it can be done."
Supports universal health care but opposes single-payer without a detailed financing plan.
"Anybody for it is selling snake oil... " Villaraigosa said. "It's got to go to a vote of the people. The people would have to double their taxes, to the tune of $200 billion dollars."
Questions how single-payer would work and opposes it without a way to pay for it.
In his health care platform, state Treasurer John Chiang repeats the call-to-action phrase championed by single-payer supporters: "Health care is a right for all, not a privilege for just the wealthy."
He said he supports efforts to expand access and coverage for the uninsured, but stopped short of committing to pursuing a single-payer system if elected, saying instead that he'd convene stakeholders to study how the state could move in that direction
"There's still a lot of questions that need to be answered," Chiang said in an interview. He said he'd do a "thorough review of programs and services," then decide how to proceed.
Unequivocally supports single-payer.
Eastin is more aligned with Newsom in her enthusiastic support. She said California must lead the nation on single-payer to lower rising health care costs and strip the profit motives of insurance companies and pharmaceutical companies out of the current system.
"I'm lucky enough to have insurance, but what about those who aren't?" she asked.
"There's an old saying 'Greed is good.' Well I don't think greed is good. It's bad, and I think it's hurting a lot of normal, ordinary people," Eastin said in an interview. "If you have a system where only the fortunate are covered, then the rest live in terror that an illness will bankrupt them, or worse."
She said she supports the current single-payer bill in the Legislature but if it dies as expected, she'd form a task force to lead the charge, if elected.
"I don't think it's snake oil," she said. "We've had other things that weren't perfect in the beginning. When they came up with Social Security, people ridiculed it and said it would bankrupt the country. Now it's a godsend for all kinds of people.
"I'm old enough to remember when Lyndon Johnson proposed Medicare, People really did say it was a horrible idea. Now it's proven to be one of the great genius moves of the 20th Century," she said. "There's too many people who are tepid and timid right now. It's like we're afraid to try something new. That isn't how we got here, so let's do it – let's fix it."
Likes the idea of single-payer but says California should focus on fixing Obamacare.
Hillary Clinton's former national political director who entered the gubernatorial race late, said she too believes single-payer should be California's long-term goal, but she'd focus first on smaller changes like creation of a public insurance option to compete with for-profit companies.
Renteria was chief of staff to Sen. Debbie Stabenow, D-Michigan, during the passage of the Affordable Care Act. Renteria said at the time the public option was not thoroughly vetted, but she believes it could work for California. She also voiced support for state efforts to cap health care payments for medical insurers and hospitals.
"I want to make sure that as we explore single-payer, we really do look at all the steps it would take to get it done," Renteria said in an interview. "Everything is on the table."