Providing universal health care coverage to 40 million Californians has become the rallying cry for the state’s Democratic Party as it drifts leftward in this election year.
Kevin de León pushed it hard when he was the president pro tem of the state Senate and was gearing up to challenge Democratic U.S. Sen. Dianne Feinstein. Health insurance zealots went ballistic when Anthony Rendon, the Democratic speaker of the state Assembly, refused to immediately take up a single-payer bill that the Senate had approved.
Rendon said he was unwilling to pass a bill that lacked a clear financing mechanism to generate the hundreds of billions of dollars that universal care would cost. Lt. Gov. Gavin Newsom, running for governor, pledged to create a universal care system as he dueled with former Los Angeles Mayor Antonio Villaraigosa, who shared Rendon’s skepticism about financing it.
Newsom bested Villaraigosa in the June primary and is now the prohibitive favorite to claim the governorship against Republican John Cox in November. Newsom argues that a universal health care system is very doable in a state as large and wealthy as California, if there is the political will to do it.
And now, health care for all Californians is essentially a matter of state law, without any real debate on how it would be implemented or financed.
One of the more than two dozen “trailer bills” that were hastily written and enacted to implement the 2018-19 state budget makes that declaration. As described in a legislative staff analysis, Assembly Bill 1810 “establishes the intent of the Legislature to provide coverage and access through a unified financing system for all Californians, to control health care and administrative costs, to ensure high-quality health care, to limit out-of-pocket costs, to train and employ an adequate health care workforce, and to ensure all Californians have timely access to necessary health care.”
That said, AB 1810 is also something of a political dodge that would let Newsom and other advocates of a single-payer system sidestep the rapid action on the issue they have said could be taken.
The measure creates a five-member “Council on Health Care Delivery Systems,” with three members appointed by the governor and two by the Legislature, to write a plan for universal health care by Oct. 1, 2021, including “a unified financing system.”
Appointing a study commission is a time-honored (or dishonored) way for politicians to buy time on a controversial issue, in this case nearly three years that would include two election cycles and the remainder of Donald Trump’s first – and, they hope, last – term in the White House.
We’ve already had such studies of universal health care, so the parameters are fairly well known.
Health care in California costs about $400 billion a year; the federal government pays 50 percent, while state government covers 20 percent. Employers and consumers pay the rest.
A single-payer system assumes that the feds would agree to funnel their money through the state, including health care for federal and military retirees. It also would require new taxes of at least $100 billion a year to cover the remainder, while presumably relieving consumers and employers of their current costs and providing health coverage to several million Californians, especially undocumented immigrants, who still lack it.
The new commission will probably reach much the same conclusion. But the final decision, if any, will be an exercise in pure power politics with immense economic consequences.
Dan Walters is a columnist at CALMatters. He can be contacted at firstname.lastname@example.org.