The California Influencer Series

‘Everyone needs it ... No one can afford it.’ Is there middle ground on California health care?

Single payer health care part of ‘battle for America’s soul,’ Gavin Newsom says

Speaking to delegates at the 2018 California Democratic Party convention, Lt. Gov. Gavin Newsom voiced his support for a single-payer health care system.
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Speaking to delegates at the 2018 California Democratic Party convention, Lt. Gov. Gavin Newsom voiced his support for a single-payer health care system.

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The California Influencers Series

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When it comes to health care reform, Gavin Newsom and John Cox are from different solar systems, not just different planets.

Newsom, the Democrat who is the strong front-runner in this year’s campaign for governor, has promised to work toward a government-run universal health care system. Cox, his conservative Republican opponent, prefers a private-sector approach.

Yet in a political climate in which both candidates face pressure from base voters with similarly huge distances between them, many of The Bee’s California Influencers reject these more polarizing alternatives in favor of solutions that establish a middle ground.

“It’s important to understand that healthcare — and community health generally — is an extraordinarily complex area that eschews simple ideological solutions…Hopefully the next governor will chart a more pragmatic middle path,” said Jim Wunderman, President and CEO of the Bay Area Council. “Both Gavin Newsom and John Cox would be wise to recognize that any solution for meeting Californians’ healthcare expectations will require a mix of approaches.”

“Selling single-payer to voters is irresponsible and impractical. Private sector based health care is insufficient,” agreed Republican consultant Mike Madrid, who advised Antonio Villaraigosa in this spring’s gubernatorial campaign. “Both candidates lack the courage to fix the problem, and it’s very unlikely either will accomplish their campaign promises on health care.”

Health care costs are clearly driving the debate.

One Sacramento Bee reader used our “Your Voice” feature to ask the Influencers to address the problem this way: “What do you consider to be the single biggest barrier to making health care less costly in California, as it is in most developed nations?”

Another asked, “How much would universal health care cost and how could it be funded?”

Angie Wei, Chief of Staff for the California Labor Federation, summed up the challenge:

“Everyone needs it, everyone cares about it. No one can afford it,” Wei said.

Two of California’s longtime political leaders discussed potential ways to tackle the problem.

Former U.S. Senator Barbara Boxer suggested “a state public option plan that California could offer to those who are dissatisfied with their current healthcare. That plan could be basic and affordable and would act to keep the private insurance market competitive,” offering what appeared to be polite advice to her fellow Democrat Newsom. “I also support this public option idea at the national level, but until there is a political sea change, all eyes will be on the states, giving our next governor a wonderful opportunity for leadership in this area.”

Republican Tom Campbell, the former U.S. Congressman who now teaches law and economics at Chapman University, also offered a more measured approach from a private-sector perspective.

“There is… some role for government: for the poor, we should provide a voucher that will automatically cover a plain-vanilla health care policy, including emergency care,” he said. “That policy should be available for purchase by anyone, but be free to the poor. For those with pre-existing conditions, we should fully fund the existing California program of a high-risk pool, with vouchers based on income.”

Wei was one of several Influencers who do support a single-payer plan, though most acknowledged the challenges associated with funding such an ambitious program.

“Gavin Newsom is right in calling for continuing the conversation on how we get to a single-payer system,” said Democratic strategist Roger Salazar. “There isn’t a Democrat in California that opposes Health Care for All. The stumbling block is how to pay for it. “

For California to create a single-payer system, it could need $200 billion from taxpayers. Here's a look at the kind of taxes increases that would be needed.

“…Newsom is right, that single-payer is necessary,” agreed Erwin Chemerinsky, Dean of the UC-Berkeley School of Law. “But no one seems to have figured out how to pay for it.”

Dorothy Rothrock, President of the California Manufacturers and Technology Association, strongly questioned the value of such an approach.

“A government-run single-payer system won’t lower costs if it simply shifts costs to businesses and citizens in the form of higher taxes while taking away competitive market features that put downward pressure on costs,” argued Rothrock.

Former Fresno Bee Editor Jim Boren, now the Executive Director of Fresno State’s Institute for Media and Public Trust, used even stronger language.

“… there’s little political chance of single-payer being implemented in California in the near future,” he said. “Pushing single-payer, without specific details, suggests you really don’t have a plan to make health care affordable and accessible to all.”

But the most formidable obstacle to many Influencers was the cavernous gap between campaign trail promises and the much more difficult realities of governing.

“I would be more confident regarding solutions if the candidates (and the media covering them) would scale back on rhetoric and soundbites and peel away the many layers when addressing this issue before voters,” said Cassandra Pye, the President of California Women Lead and Founder and CEO of 3.14 Communications. “Even then, the next governor will have to contend with well-funded interests who won’t want to give away any of their portions of the health care pie.”

Dan Schnur, a veteran analyst and longtime participant in California politics, is director of the California Influencers series for The Sacramento Bee and McClatchy.

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